British journal of anaesthesia
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Review Meta Analysis
Systematic review and meta-analysis of the effect of intraoperative α2-adrenergic agonists on postoperative behaviour in children.
Intraoperative clonidine or dexmedetomidine significantly reduce emergence delirium in children after general anaesthesia (OR 0.28)
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Review Meta Analysis
Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis.
Intra-operative use of remifentanil may have a dose-response effect on inducing hyperalgesia and consequentially increasing post-operative pain.
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MAC (minimum alveolar concentration of an inhaled anaesthetic) and CP₅₀i (minimum plasma concentration of i.v. anaesthetics) are well-established measures to compare potencies of anaesthetics. The underlying clinical endpoint immobility reflects mainly effects of anaesthetics on the spinal cord, which limits the use of this measure for comparison of effects on the main target organ of general anaesthesia--the brain. The present study determines the median concentration of sevoflurane, isoflurane, and propofol that induce the onset of electroencephalogram (EEG) suppression ('silent second'): MACBS and CP₅₀BS. ⋯ Immobility and cerebral effects reflect different entities of anaesthetic action. The median concentration of anaesthetic drug (volatile or i.v. agent) required to induce 'silent second' might be a more useful metric than the median concentration required to prevent movement in response to a surgical stimulus in order to compare relative potencies of anaesthetic agents on the brain. Advantage of the 'silent second' is an easy identification of this endpoint, while such a deep level is not required for clinical anaesthesia.
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Randomized Controlled Trial
Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial.
Sharing information with the team is critical in developing a shared mental model in an emergency, and fundamental to effective teamwork. We developed a structured call-out tool, encapsulated in the acronym 'SNAPPI': Stop; Notify; Assessment; Plan; Priorities; Invite ideas. We explored whether a video-based intervention could improve structured call-outs during simulated crises and if this would improve information sharing and medical management. ⋯ We developed a structured communication tool, SNAPPI, to improve information sharing between anaesthetists and their team, taught it using a video-based intervention, and provide initial evidence to support its value for improving communication in a crisis.