British journal of anaesthesia
-
Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. ⋯ Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit. Whether this leads to fewer intraoperative complications, an improved quality of recovery, or both after laparoscopic surgery should be pursued in future studies. The review methodology was specified in advance and registered at Prospero on July 27, 2016, registration number CRD42016042144.
-
Randomized Controlled Trial
Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers.
Daily and globally, millions of adult hospitalized patients are exposed to maintenance i.v. fluid solutions supported by limited scientific evidence. In particular, it remains unclear whether fluid tonicity contributes to the recently established detrimental effects of fluid, sodium, and chloride overload. ⋯ ClinicalTrials.gov (NCT02822898) and EudraCT (2016-001846-24).
-
Randomized Controlled Trial Comparative Study Observational Study
Comparative total and unbound pharmacokinetics of cefazolin administered by bolus versus continuous infusion in patients undergoing major surgery: a randomized controlled trial.
Perioperative administration of cefazolin reduces the incidence of perioperative infections. Intraoperative re-dosing of cefazolin is commonly given between 2 and 5 h after the initial dose. This study was undertaken to determine whether intraoperative continuous infusions of cefazolin achieve better probability of target attainment (PTA) and fractional target attainment (FTA) than intermittent dosing. ⋯ NCT02058979.
-
Randomized Controlled Trial Comparative Study
Randomized equivalence trial of the King Vision aBlade videolaryngoscope with the Miller direct laryngoscope for routine tracheal intubation in children <2 yr of age.
We conducted a randomized equivalence trial to compare direct laryngoscopy using a Miller blade (DL) with the King Vision videolaryngoscope (KVL) for routine tracheal intubation. We hypothesized that tracheal intubation times with DL would be equivalent to the KVL in children <2 yr of age. ⋯ NCT02590237.
-
Perioperative anaemia is common. Physicians believe that patients at increased cardiac risk do not tolerate anaemia and, consequently, these patients receive transfusions earlier and more often. This practice runs counter to a growing body of evidence that perioperative red blood cell (RBC) transfusion is harmful The aims of this study were as follows: (i) to assess the effects of transfusion at moderate to severely low ranges of postoperative haemoglobin concentrations; and (ii) to assess whether transfusion was beneficial in patients at high cardiac risk within these haemoglobin ranges. ⋯ High cardiac risk was associated with increased incidence of anaemia, transfusion, and mortality. Red blood cell transfusion is associated with reduced mortality only in high cardiac risk patients with nadir postoperative haemoglobin concentration <80 g litre -1 . Transfusion, the main treatment for postoperative anaemia, does not appear to be associated with reduced postoperative mortality at higher nadir haemoglobin ranges.