Anaesthesia
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The PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence-based consensus recommendations for the effective management of postoperative pain are then developed from these systematic reviews, incorporating clinical practice observations, and transferable evidence from other relevant procedures. ⋯ The evidence from this review supports the use of general anaesthesia combined with a femoral nerve block for surgery and postoperative analgesia, or alternatively spinal anaesthesia with local anaesthetic plus spinal morphine. The primary technique, together with cooling and compression techniques, should be supplemented with paracetamol and conventional non-steroidal anti-inflammatory drugs or COX-2-selective inhibitors, plus intravenous strong opioids (high-intensity pain) or weak opioids (moderate- to low-intensity pain).
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Multicenter Study
Modelling patient flows as an aid to decision making for critical care capacities and organisation.
Using real data from a number of hospitals, we predicted the patient flows following a capacity or organisational change. Clinically recognisable patient groups obtained through classification and regression tree analysis were used to tune a simulation model for the flow of patients in critical care units. ⋯ Where available the predictions' accuracy was checked by comparison with real hospital data collected after an actual capacity change. The model takes variability and uncertainty properly into account and it provides the necessary information for making better decisions about critical care capacity and organisation.
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Randomized Controlled Trial Comparative Study
The effects of interrupted or continuous administration of sevoflurane on preconditioning before cardio-pulmonary bypass in coronary artery surgery: comparison with continuous propofol.
Volatile anaesthetics have been shown to exert cardioprotective properties in experimental and clinical studies. However, the mode of administration may influence these cardioprotective effects. The present study was designed to compare the effect of interrupted administration of sevoflurane before cardiopulmonary bypass with continuous sevoflurane administration and with propofol-only anaesthesia, on cardioprotection as assessed by left ventricular performance and myocardial cell damage during coronary artery bypass grafting. ⋯ CK-MB levels were also significantly (p < 0.05) lower in the SevoI group at 24 h after surgery and MPI significantly improved compared with both the P and SevoC groups. There was, however, no difference with respect to cytokine release and length of stay in either the intensive care unit or in the hospital. We conclude that prior interrupted sevoflurane administration confers some cardioprotection as compared with continuous sevoflurane administration or propofol-based anaesthesia.
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We have developed a questionnaire to assess patients' peri-anaesthetic satisfaction. We recruited 1398 patients and 59 health care professionals for construction and validation. Relevant items were rated for preferences. ⋯ Multivariate analysis found significant influences of age, school education, marital status and duration of anaesthesia. Dissatisfied patients had a median (IQR [range]) of 73% (66-76% [35-83]), and satisfied patients 92% (90-94% [88-100]) of the sum score. The Heidelberg Peri-anaesthetic Questionnaire offers a valid and reliable way to identify dissatisfied patients and generate quality improvement and also has use as a benchmark tool.
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Randomized Controlled Trial
The effect of temperature on bougies: a photographic and manikin study.
We investigated the effect of temperature on single use and reuseable bougies. In a photographic study, three bougies (Portex Venn reuseable (R), Portex single use (S) and Breathesafe single use (B)) were exposed to increasing temperatures and sequential photographs were taken of the bougies uncoiling from a preformed curve. Bougie type was associated with rate of uncoiling, type R maintaining its curve the longest but changing temperature did not affect this. ⋯ Change of temperature was significant with success rate increasing with lower temperature. The odds of success at 10 degrees C was six times that at 30 degrees C (OR (95%) 6.7 (1.7, 25.7)). We concluded that both bougies performed best at 10 degrees C.