British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement.
Total knee arthroplasty (TKA) is often carried out using a tourniquet and shed blood is collected in drains. Tranexamic acid decreases the external blood loss. Some blood loss may be concealed, and the overall effect of tranexamic acid on the haemoglobin (Hb) balance is not known. ⋯ Tranexamic acid decreased total blood loss by nearly 30%, drainage volume by approximately 50% and drastically reduced transfusion. However, concealed loss was only marginally influenced by tranexamic acid and was at least as large as the drainage volume.
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Exhaled nitric oxide (NO) may reflect NO production and consumption but the pulmonary origin of NO in exhaled gas is not clear. There are also conflicting data on exhaled NO after cardiopulmonary bypass (CPB). Because intravenous nitrovasodilators increase exhaled NO by conversion to NO in the lung, we measured basal and nitroglycerin (GTN)-induced exhaled NO in patients having low-risk coronary artery bypass graft (CABG) operations using routine CPB. We reasoned that GTN-induced exhaled NO would be a primarily vascular mechanism, which would contrast with the airway epithelial origin of basal exhaled NO, and that they might be differentially influenced by CPB. ⋯ The capacity of the lungs to increase exhaled NO in response to intravenous GTN is reduced after CPB, suggesting microvascular injury and/or atelectasis after routine open-heart surgery.
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Non-technical skills are critical for good anaesthetic practice but are not addressed explicitly in normal training. Realization of the need to train and assess these skills is growing, but these activities must be based on properly developed skills frameworks and validated measurement tools. A prototype behavioural marker system was developed using human factors research techniques. The aim of this study was to conduct an experimental evaluation to establish its basic psychometric properties and usability. ⋯ The findings of the evaluation indicated that the ANTS system has a satisfactory level of validity, reliability and usability in an experimental setting, provided users receive adequate training. It is now ready to be tested in real training environments, so that full guidelines can be developed for its integration into the anaesthetic curriculum.
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Randomized Controlled Trial Clinical Trial
Age- and therapy-related effects on morphine requirements and plasma concentrations of morphine and its metabolites in postoperative infants.
To investigate clinical variables such as gestational age, sex, weight, the therapeutic regimens used and mechanical ventilation that might affect morphine requirements and plasma concentrations of morphine and its metabolites. ⋯ Neonates have a narrower therapeutic window for postoperative morphine analgesia than older age groups, with no difference in the safety or effectiveness of intermittent doses compared with continuous infusions in any of these age groups. In infants >1 month of age, analgesia is achieved after morphine infusions ranging from 10.9 to 12.3 micro g kg(-1) h(-1) at plasma concentrations of <15 ng ml(-1).