British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study
Effect of sleep deprivation on labour epidural catheter placement.
Epidural catheter insertion for labour analgesia is an invasive procedure with potential serious complications, often performed by a sleep-deprived clinician. The aim of this study was to examine the effects of sleep deprivation on physicians of variable levels of experience performing this procedural skill in the clinical setting. ⋯ The performance of this procedural skill in a clinical setting does not seem to be affected by sleep deprivation irrespective of the level of experience.
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Randomized Controlled Trial Multicenter Study
Lung recruitment and positive airway pressure before extubation does not improve oxygenation in the post-anaesthesia care unit: a randomized clinical trial.
Atelectasis is known to develop during anaesthesia and after operation atelectasis leads to impaired oxygenation. Lung recruitment manoeuvres, positive end-expiratory pressure (PEEP), and continuous positive airway pressure (CPAP) have been proposed for reduction of atelectasis but their benefits have not been shown to persist after operation. We proposed that a combination of these techniques before extubation would improve oxygenation after operation. ⋯ Postoperative oxygenation is not improved by a combination of a lung recruitment manoeuvre and maintenance of a positive airway pressure until extubation. Further research is needed to elucidate the mechanism of atelectasis on emergence from anaesthesia and to evaluate more invasive clinical strategies such as post-extubation CPAP. Trial registered at URL http://www.controlled-trials.com Identification number: ISRCTN32464251 (http://www.controlled-trials.com/ISRCTN32464251).
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Ultrasound guidance for regional anaesthesia has gained enormous popularity in the past decade. The use of ultrasound guidance for many regional anaesthetic techniques is common in daily clinical practice, and the number of practitioners using it is increasing. However, alongside the enthusiasm, there should be a degree of informed scepticism. ⋯ It also attempts to define a 'gold standard' in regional anaesthesia with the most recent findings in adequate volumes of local anaesthetics for peripheral nerve blocks. This standard should include an extraneural needle position, a high success rate, and wide application of ultrasound guidance in regional anaesthesia. The second part describes the impact of ultrasound on the development of nerve block techniques in the past 5 yr.
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Local anaesthetic blocks of the greater occipital nerve (GON) are frequently performed in different types of headache, but no selective approaches exist. Our cadaver study compares the sonographic visibility of the nerve and the accuracy and specificity of ultrasound-guided injections at two different sites. ⋯ Our findings confirm that the GON can be visualized using ultrasound both at the level of the superior nuchal line and C2. This newly described approach superficial to the obliquus capitis inferior muscle has a higher success rate and should allow a more precise blockade of the nerve.
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Normalization of plasma fibrinogen levels may be associated with satisfactory haemostasis and reduced bleeding. The aim of this retrospective study was to assess fibrinogen recovery parameters after administration of fibrinogen concentrate (Haemocomplettan P) to patients with diffuse bleeding in cardiovascular surgery. Data on transfusion and patient outcomes were also collected. ⋯ In this retrospective study, fibrinogen concentrate was effective in increasing plasma fibrinogen level, and contributed to the correction of bleeding after cardiovascular surgery.