Anaesthesia
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Review Meta Analysis Comparative Study
Intra-operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta-analysis with trial sequential analysis.
Intraoperative dexmedetomidine infusions result in less postoperative pain, hypotension, shivering and PONV than remifentanil.
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Multicenter Study
Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study.
At nadir haemoglobin above 90 g/L in-hospital, 30-day and 1-year mortality is higher with transfusion.
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Randomized Controlled Trial Multicenter Study Retracted Publication
A multicentre randomised controlled trial of the effect of intra-operative dexmedetomidine on cognitive decline after surgery.
Dexmedetomidine may reduce post-operative delirium and at one month post-operative cognitive decline in elderly patients, associated with changes in brain-derived neurotrophic factor.
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Most anaesthetists using target-controlled infusion systems will have observed that the calculated effect-site concentration at loss of consciousness is usually higher than the concentration at emergence. Inertia is the ability of biological systems to keep a functional state at rest or in activity and is an active process of resistance to change in state. ⋯ Recently, a phenomenon called neuronal inertia has been proposed when trying to explain the resistance observed to changes in consciousness induced by general anaesthesia, independent of drug kinetics. This review discusses the existence of this phenomenon and the conceptual and practical impact it may have on induction and recovery from general anaesthesia.
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Randomized Controlled Trial Multicenter Study
The impact of pre-operative intravenous iron on quality of life after colorectal cancer surgery: outcomes from the intravenous iron in colorectal cancer-associated anaemia (IVICA) trial.
Anaemia is associated with a reduction in quality of life, and is common in patients with colorectal cancer. We recently reported the findings of the intravenous iron in colorectal cancer-associated anaemia (IVICA) trial comparing haemoglobin levels and transfusion requirements following intravenous or oral iron replacement in anaemic colorectal cancer patients undergoing elective surgery. In this follow-up study, we compared the efficacy of intravenous and oral iron at improving quality of life in this patient group. ⋯ The Functional Assessment of Cancer Therapy - Anaemia score comprises of subscales related to cancer, fatigue and non-fatigue items relevant to anaemia. Median outpatient scores were higher, and hence favourable, for intravenous iron on the Functional Assessment of Cancer Therapy - Anaemia subscale (oral iron 66 (55-72 [23-80]); intravenous iron 71 (66-77 [46-80]); p = 0.002), Functional Assessment of Cancer Therapy - Anaemia trial outcome index (oral iron 108 (90-123 [35-135]); intravenous iron 121 (113-124 [81-135]); p = 0.003) and Functional Assessment of Cancer Therapy - Anaemia total score (oral iron 151 (132-170 [69-183]); intravenous iron 168 (160-174 [125-186]); p = 0.005). These findings indicate that intravenous iron is more efficacious at improving quality of life scores than oral iron in anaemic colorectal cancer patients.