British journal of anaesthesia
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Randomized Controlled Trial
Hyaluronidase reduces local anaesthetic volumes for sub-Tenon's anaesthesia.
Volumes of local anaesthetics for sub-Tenon's anaesthesia vary. Lower volumes produce less akinesia, whereas higher volumes increase chemosis and intra-ocular pressures. Hyaluronidase is often added to local anaesthetics to improve akinesia without increasing the volume of the injection, but this is controversial. This randomized, sequential allocation study examines the addition of hyaluronidase on the minimum local anaesthetic volume (MLAV) required for a sub-Tenon's block. ⋯ Hyaluronidase permits a significant 2.4-fold (95% CI, 1.8-3.4) reduction in MLAV for sub-Tenon's anaesthesia.
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Randomized Controlled Trial Multicenter Study
Sevoflurane preconditioning at 1 MAC only provides limited protection in patients undergoing coronary artery bypass surgery: a randomized bi-centre trial.
Volatile agents can mimic ischaemic preconditioning leading to a decrease in myocardial infarct size. The present study investigated if a 15 min sevoflurane administration before cardiopulmonary bypass (CPB) has a cardioprotective effect in patients undergoing coronary surgery. ⋯ This study did not show a significant preconditioning signal after 15 min of sevoflurane administration. The 15 min duration might be too short or the concentration of sevoflurane too low to induce cardioprotection detected by troponin I levels.
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Randomized Controlled Trial Comparative Study
Simulation as an additional tool for investigating the performance of standard operating procedures in anaesthesia.
In medicine, the use of standard operating procedures (SOPs) is often evaluated using questionnaires (QUES). However, QUES can have limitations with regard to method, thus leading to errors. Simulation (SIM) offers another opportunity for evaluation. We hypothesized that medical errors in the evaluation of SOPs using QUES could be detected by SIM, and that SIM is better qualified to demonstrate applied medicine. ⋯ QUES and SIM are powerful instruments for evaluating the implementation of SOPs such as RSI. SIM demonstrates automated behaviours and thus more clearly represents behaviours used in clinical practice than is possible to demonstrate using QUES. Using a combination of these two instruments, method errors resulting from the individual instruments can be reduced.
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Randomized Controlled Trial Comparative Study
Randomized, double-blind study comparing the efficacy of moderate-dose metoclopramide and ondansetron for the prophylactic control of postoperative vomiting in children after tonsillectomy.
Postoperative vomiting (POV) is a major cause of morbidity after tonsillectomy in children. It has been well established that anti-serotinergic agents are effective for the prophylactic control of POV in this patient group. It has been suggested that at moderate doses (0.5 mg kg(-1)), metoclopramide is also an effective agent. No study has been performed comparing the efficacy of an anti-serotinergic agent and moderate-dose metoclopramide. ⋯ Although the incidence of vomiting was similar, when these results are compared with a pre-specified zone of equivalence of 0-15%, it cannot be concluded that the effect of metoclopramide is equivalent to ondansetron. Survival analysis indicated that those in the metoclopramide group vomited substantially earlier. It is concluded, therefore, that ondansetron 0.1 mg kg(-1) is a superior drug to metoclopramide 0.5 mg kg(-1) for the prophylactic control of POV in children undergoing tonsillectomy.
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Randomized Controlled Trial
Narcotrend-assisted propofol/remifentanil anaesthesia vs clinical practice: does it make a difference?
The Narcotrend is a computer-based EEG monitor designed to measure the depth of anaesthesia. The aim of the present study is to test the hypothesis that the intraoperative level of anaesthetic depth differs if decision-making is guided by Narcotrend monitoring or not. ⋯ Guidance of anaesthesia with the Narcotrend-monitor leads to fewer deviations from a defined target than clinical assessment of anaesthetic depth only. This results in lower scores of nausea in the immediate period after anaesthesia.