British journal of anaesthesia
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Comparative Study
Anaesthetic technique may affect prognosis for ovarian serous adenocarcinoma: a retrospective analysis.
Animal studies have shown that regional anaesthesia and analgesia may prevent or attenuate the surgical stress response by preserving immune function and result in better long-term outcome. We have tested the hypothesis that patients with ovarian serous adenocarcinoma who had surgery with epidural anaesthesia and analgesia would have better long-term outcome than those who were given general anaesthesia (GA) and i.v. opioid analgesia. ⋯ This retrospective analysis suggests that epidural anaesthesia and analgesia for ovarian serous adenocarcinoma surgery may reduce mortality during the initial years of follow-up.
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Recent studies in anaesthesia and intensive care indicate that a team's ability to adapt its coordination activities to changing situational demands is crucial for effective teamwork and thus, safe patient care. This study addresses the relationship between adaptation of team coordination and markers of clinical performance in response to a critical event, particularly regarding which types of coordination activities are used and which team member engages in those coordination activities. ⋯ Our findings support the claim that adaptation of coordination activities is related to improved team performance in healthcare. Moreover, adaptation and its relationship to team performance were found to vary with regard to type of coordination activities and team member.
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Remifentanil undergoes extensive placental transfer and has been used to provide fetal immobilization and anaesthesia for in utero fetal endoscopic interventions. We report three cases of the ex utero intrapartum treatment performed under neuraxial anaesthesia where the maternal administration of remifentanil was used to provide fetal immobilization and analgesia. Fetal pathology included goiter and arthrogryposis, with one case requiring a tracheostomy. ⋯ No clinically significant maternal sedation or respiratory depression was observed. In all cases, remifentanil provided adequate fetal immobilization and obviated the need to administer other analgesics or neuromuscular blocking agents. Remifentanil is a useful adjunct for ex utero fetal procedures.