British journal of anaesthesia
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Surgical repair of hip fractures is associated with high postoperative mortality. The identification of high-risk patients might be of value in aiding clinical management decisions and resource allocation. The Nottingham Hip Fracture Score (NHFS) is a scoring system validated for the prediction of 30 day mortality after hip fracture surgery. It is made up of seven independent predictors of mortality that have been incorporated into a risk score: age (66-85 and ≥86 yr); sex (male); number of co-morbidities (≥2), admission mini-mental test score (≤6 out of 10), admission haemoglobin concentration (≤10 g dl(-1)), living in an institution; and the presence of malignancy. We investigated whether the NHFS was a predictor of 1 yr mortality in patients undergoing surgical repair of fractured neck of femur. ⋯ NHFS can be used to stratify the risk of 1 yr mortality after hip fracture surgery.
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Randomized Controlled Trial Comparative Study
Analgesia and pulmonary function after lung surgery: is a single intercostal nerve block plus patient-controlled intravenous morphine as effective as patient-controlled epidural anaesthesia? A randomized non-inferiority clinical trial.
Thoracic epidural anaesthesia (EDA) is regarded as the 'gold standard' for postoperative pain control and restoration of pulmonary function after lung surgery. Easier, less time-consuming, and, perhaps, safer is intercostal nerve block performed under direct vision by the surgeon before closure of the thoracotomy combined with postoperative i.v. patient-controlled analgesia with morphine. We hypothesized that this technique is as effective as thoracic EDA. ⋯ In patients undergoing lung surgery, single intercostal nerve block plus i.v. patient-controlled analgesia with morphine is not as effective as patient-controlled EDA with respect to pain control and restoration of pulmonary function.
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Dyspnoea is the result of a complex interaction of physiological, psychosocial, social, and environmental factors. Although several sensory receptors located throughout the respiratory system are considered to be responsible for generation of dyspnoea, there is no afferent receptor solely responsible for the sensation of dyspnoea. Afferent information from the sensory receptors is processed at the cortex along with the respiratory motor command from the cortex and brainstem, and a mismatch between the motor command and the incoming afferent information may result in dyspnoea. ⋯ Recent neuroimaging studies suggest that neural structures subserving pain and dyspnoea might be shared, and therefore the neurophysiological and psychophysical approaches used to understand pain can be applied to dyspnoea research. Although effective treatment of dyspnoea remains an elusive goal at the moment, a better understanding of the pathophysiology and neurophysiology of dyspnoea may provide a rationale for effective therapy of dyspnoea. In this context, treatment strategies in dyspnoea should be similar to those used in pain.
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Comparative Study
Lack of agreement between pulmonary arterial thermodilution cardiac output and the pressure recording analytical method in postoperative cardiac surgery patients.
Pulse-contour analysis method (PCM) cardiac output (CO) monitors are increasingly used for CO monitoring during anaesthesia and in the critically ill. Very recently, several systems have been introduced that do not need calibration; among them the pressure recording analytical method (PRAM). Sparse data comparing the accuracy of the PRAM-CO with conventional thermodilution CO (ThD-CO) in cardiac surgery patients are available. ⋯ These results question the reliability of the PRAM technology for the determination of CO in postoperative cardiac surgery patients.