British journal of anaesthesia
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There are few scientific reports documenting the effects of simulation training on learning. Issues of scientific validity challenge investigators who measure such outcomes. We perceived a failure of residents to change their technical management of oesophageal intubation after simulation training and sought clarification of this observation. ⋯ This failure to change may have been secondary to a lack of criterion validity, lack of repetition or a long duration between episodes. The expectations for management were not regarded as being advantageous in simulation, but they were successfully adopted in actual clinical emergencies.
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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.