Anaesthesia
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Propofol-based total intravenous anaesthesia is well known for its smooth, clear-headed recovery and anti-emetic properties, but there are also many lesser known beneficial properties that can potentially influence surgical outcome. We will discuss the anti-oxidant, anti-inflammatory and immunomodulatory effects of propofol and their roles in pain, organ protection and immunity. We will also discuss the use of propofol in cancer surgery, neurosurgery and older patients.
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Shared decision-making is central to the pre-operative consent process and accurate communication of risk is dependent on a clear understanding of numerical information by both the patient and clinician. The risk of an adverse event or complication is often described using verbal probability expressions but how these are interpreted by clinicians and patients in the pre-operative setting has not been studied. We asked patients and clinicians to assign a numerical translation (as a percentage) for seven verbal probability expressions in relation to the probability of a major peri-operative complication occurring. ⋯ Patients assigned a wider range of percentage values to each of the verbal probability expressions and these were all significantly higher than those assigned by clinicians: median (IQR [range]) negligible risk 5% (1-15 [0-100]) vs. 0% (0-0 [0-5]); minimal risk 5% (2-10) [0-100]) vs. 1% (0-1 [0-10]); low risk 10% (3-10 [0-100]) vs. 1% (0-2) [0-10]); standard risk 20% (10-40) [0-100]) vs. 1% (1-5) [0-30]); moderate risk 33% (20-50) [0-100]) vs. 5% (3-10) [0-80]); high risk 70% (30-90 [0-100]) vs. 15% (10-40) [1-75]); and very high risk 90% (50-95 [0-100]) vs. 40% (20-50 [5-100]), respectively (p < 0.005 for all comparisons). There is considerable variation in the numerical translation of verbal probability expressions by both patients and clinicians. This suggests that verbal probability expressions should not be used in isolation as part of doctor-patient discussions regarding peri-operative risk.
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Multicenter Study
Variation in the practice of tracheal intubation in Europe after traumatic brain injury: a prospective cohort study.
Traumatic brain injury patients frequently undergo tracheal intubation. We aimed to assess current intubation practice in Europe and identify variation in practice. We analysed data from patients with traumatic brain injury included in the prospective cohort study collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) in 45 centres in 16 European countries. ⋯ In conclusion, patient and injury characteristics are key drivers of tracheal intubation. Between-centre differences were also substantial. Further studies are needed to improve the evidence base supporting recommendations for tracheal intubation.