British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Randomized controlled trial of duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children.
Doses of acetaminophen 40 mg kg(-1) rectally and 15 mg kg(-1) i.v. produce similar effect-site concentrations. However, the clinical effectiveness of these routes has not been compared. The aim of this study was to compare duration and efficacy of analgesia in children following adenotonsillectomy after acetaminophen either 40 mg kg(-1) rectally or 15 mg kg(-1) i.v. ⋯ Rectal acetaminophen 40 mg kg(-1) provides longer analgesia for moderately painful procedures when compared with 15 mg kg(-1) acetaminophen i.v.
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Comparative Study
Delta down compared with delta pulse pressure as an indicator of volaemia during intracranial surgery.
Delta pulse pressure (DPP) and delta down (DD) are indicators of volaemia. The threshold value of DPP for discriminating between responders and non-responders to fluid loading (FL) is 13%. This study aimed at comparing DD with DPP during intracranial surgery. ⋯ DD is as efficient as DPP to assess hypovolaemia and predict responsiveness to FL in patients undergoing intracranial surgery. A 5 mm Hg DD value can be considered as a valuable threshold for initiating FL. These results support its use during intracranial surgery.
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Little research has been performed on designing appointment systems for the preoperative assessment clinic (PAC). We aimed to investigate how two organizational planning difficulties, (i) long access times and (ii) long waiting times, could be analysed systematically. ⋯ This study shows that a simulation model is a helpful tool to determine the capacity needed to achieve and to maintain a proposed service level for access times and waiting times. In addition, waiting times at the PAC can be reduced by making the reserved consultation time dependent on patients' ASA physical status.
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Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable changes in physiology but also with a number of complications, and safe use of the prone position requires an understanding of both issues. ⋯ The complications associated with this position and the published techniques for various practical procedures in this position will be discussed. The aim of this review is to identify the risks associated with prone positioning and how these risks may be anticipated and minimized.