British journal of anaesthesia
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We studied the potential neuroprotective effects of halothane and desflurane, compared with the awake state, on infarct size following 2 h of intraluminal middle cerebral artery occlusion (MCAo) and 22 h of reperfusion. ⋯ In rats, desflurane-induced neuroprotection against focal cerebral ischaemia was greater than that conferred by halothane.
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Randomized Controlled Trial Clinical Trial
Propacetamol augments inhibition of platelet function by diclofenac in volunteers.
Acetaminophen (paracetamol) enhances the analgesic effect of non-steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen is a weak inhibitor of cyclooxygenase (COX), and its combination with an NSAID may augment COX inhibition-related side effects. ⋯ The combination of propacetamol and diclofenac inhibits platelet function more than diclofenac alone. This should be considered when assessing the risk of surgical bleeding.
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Multicenter Study
Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia.
Expert professional practice in any field is known to rely on both explicit (formal) and tacit (personal) forms of knowledge. Current anaesthetic training programmes appear to favour explicit knowledge and measurable competencies. We aimed to describe and explore the way different types of knowledge are learned and used in anaesthetic practice. ⋯ Opportunities for developing expertise are linked to the independent development of personal routines. Evidence-based approaches to professional practice may obscure the role played by the interpretation of knowledge. We suggest that the restriction of apprenticeship-style training threatens the acquisition of anaesthetic expertise as defined in this paper.
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Randomized Controlled Trial Clinical Trial
Non-selective and cyclo-oxygenase-2-specific non-steroidal anti-inflammatory drugs impair the hyperaemic response of skin to brief axillary artery occlusion.
Cyclo-oxygenase-2 (COX-2)-specific inhibitors are marketed as safer analgesics than non-selective non-steroidal anti-inflammatory drugs. However, there has been conflicting evidence concerning endothelial function and cardiovascular risk after COX-2 inhibitor use. We investigated forearm skin vascular reactivity to brief axillary artery occlusion in healthy volunteers after a single dose of the non-steroidal anti-inflammatory drugs ibuprofen (non-selective) and rofecoxib (COX-2 specific). ⋯ Both COX-2 and non-selective non-steroidal anti-inflammatory drugs, when given to healthy volunteers as single therapeutic doses, decrease skin microvascular tone but do not impair maximal vasodilatory ability.
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There is good evidence to support the use of a "protective" ventilation strategy, using small tidal volumes and inspiratory pressures, in patients with acute respiratory distress syndrome. Many general intensive care units in the UK are being slow to adopt this approach and we therefore set out to devise a method to audit ventilation and possibly influence practice in these units. ⋯ To assist progress towards the use of a "protective" ventilation strategy in intensive care units in the UK, we devised a simple, robust audit method. We have shown how this method can give a more uniform practice of ventilation in critical care units, with the introduction of nurse-run protocols.