British journal of anaesthesia
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Latin American countries have a huge diversity in sociocultural factors, ethnicity, geography, and political systems. Provision of healthcare varies widely in Latin America, and it is unclear how these disparities relate to outcomes for individual patients undergoing surgery. The Latin American Surgical Outcome Study (LASOS), with its pragmatic design, will provide a snapshot of surgical activity throughout Latin America and identify the next steps needed to improve postoperative outcomes.
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Intensive care unit (ICU) sedation with sevoflurane is associated with nephrogenic diabetes insipidus. Given that isoflurane is now licenced (in Europe) for ICU sedation and has Investigational New Drug status in the USA, evidence indicates that clinicians should stop using sevoflurane in this indication except in the context of clinical trials.
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Enhanced recovery programmes reduce hospitalisation and medical complications across procedures, but unfortunately there have well-documented difficulties in implementation. Some recovery programmes include many components that hinder widespread implementation. The delivery of Drinking, Eating, and Mobilising (DrEaMing) bundle, with its focus on drinking, eating, and mobilising, may serve as a simple combined process, outcome measure, or both, thereby facilitating further progress in monitoring, auditing, implementation, and improvement of enhanced recovery programmes.
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Use of pulmonary artery catheters on general intensive care units has declined. Reasons for this decline are explored and the evidence for and against their use is re-examined. We conclude that the growing consensus for a lack of benefit is not justified, and use of pulmonary artery catheters can still be appropriate.