Anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of supplemental pre-operative fluid on postoperative nausea and vomiting.
In a prospective, double-blind, randomised controlled trial, we studied the effects of pre-operative fluid load on post-operative nausea and vomiting. Eighty patients attending for laparoscopic cholecystectomy or gynaecological surgery were randomly allocated to receive 2 ml.kg-1 (conservative) or 15 ml.kg-1 (supplemental) Hartmann's solution intravenously, shortly before induction of anaesthesia. ⋯ During the first post-operative 24 h, post-operative nausea and vomiting occurred in 29 patients (73%) in the conservative fluid group and nine patients (23%) in the supplemental fluid group (p = 0.01). Supplemental pre-operative fluid is an inexpensive and safe therapy for reducing post-operative nausea and vomiting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain during awake nasal intubation after topical cocaine or phenylephrine/lidocaine spray.
Although several local anaesthetic techniques are described for nasal analgesia during awake intubation, there has been little attempt to evaluate their effectiveness. We examined pain scores associated with nasal intubation in a randomised cross-over study of 25 volunteers. ⋯ Larger diameter tubes resulted in higher pain scores. There was no difference in pain scores between the two drugs.
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The effects of introducing Modified Early Warning scores to identify medical patients at risk of catastrophic deterioration have not been examined. We prospectively studied 1695 acute medical admissions. All patients were scored in the admissions unit. ⋯ The therapeutic interventions performed in response to abnormal scores were not assessed. We are convinced that the Modified Early Warning score is a suitable scoring tool to identify patients at risk. However, outcomes in medical emergency admissions are influenced by a multitude of factors and so it may be difficult to demonstrate the score's benefit without further standardizing the response to abnormal values.