British journal of anaesthesia
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There are many patient groups who may refuse blood products; the most well known amongst them is the Jehovah's Witness faith. Treatment of anaemia and bleeding in such patients presents a challenge to medical, anaesthetic, and surgical teams. This review examines the perioperative issues and management of Jehovah's Witnesses. The history and beliefs of Jehovah's Witnesses are outlined together with their impact on ethics and the law, and different management options throughout the perioperative period are discussed.
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We have evaluated the pitfalls in reporting sample size calculation in randomized controlled trials (RCTs) published in the 10 highest impact factor anaesthesia journals. Superiority RCTs published in 2013 were identified and checked for the basic components required for sample size calculation and replication. The difference between the reported and replicated sample size was estimated. ⋯ Studies using data derived from pilot studies for sample size calculation were associated with the smallest Δ gaps (P=0.008). Sample size calculation is frequently reported in anaesthesia journals, but the details of basic elements for calculation are not consistently provided. In almost one-third of RCTs, the reported and replicated sample sizes were not identical and the assumptions for the expected effect size and variance were not supported by relevant literature or pilot studies.
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Meta Analysis
The Effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials.
Inotropes and vasopressors are frequently administered to critically ill patients in order to improve haemodynamic function and restore adequate organ perfusion. However, some studies have suggested a possible association between inotrope administration and increased mortality. We therefore performed a meta-analysis of randomized trials published in the last 20 yr to investigate the effect of these drugs on mortality. ⋯ Our systematic review found that inotrope/vasopressor therapy is not associated with differences in mortality in the overall population and in the majority of subsettings.
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Randomized Controlled Trial Comparative Study
Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection.
The different methods of cervical epidural injection include the median or paramedian interlaminar (PI) approach and the transforaminal (TF) approach. We hypothesized that the modified PI (mPI) approach could deliver drugs suitably and safely into the anterior epidural space compared with the TF approach. ⋯ This result suggests that the mPI approach allows for suitable and safe delivery of drugs into the anterior epidural space.
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Arterial blood pressure lability, defined as rapid changes in arterial blood pressure, occurs commonly during anaesthesia. It is believed that hypertensive patients exhibit more lability during surgery and that lability is associated with poorer outcomes. Neither association has been rigorously tested. We hypothesized that hypertensive patients have more blood pressure lability and that increased lability is associated with increased 30 day mortality. ⋯ Intraoperative arterial blood pressure lability occurs more often in hypertensive patients. Contrary to common belief, increased lability was associated with decreased 30 day mortality.