British journal of anaesthesia
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Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity. ⋯ CRD42023399373 (PROSPERO).
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Editorial Review
The safety of nitrous oxide: glass half-full or half-empty?
A systematic review of clinical trials confirms that including nitrous oxide in the gas mixture for general anaesthesia has minor short-term benefits and does not impact most patient safety outcomes. However, no risk-benefit analysis of nitrous oxide should ignore its known environmental effects. If continued nitrous oxide use is supported, strategies to minimise and monitor the contribution of medical nitrous oxide to global warming are vital.
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Randomized Controlled Trial Multicenter Study
The effect of high protein dosing in critically ill patients: an exploratory, secondary Bayesian analyses of the EFFORT Protein trial.
The EFFORT Protein trial assessed the effect of high vs usual dosing of protein in adult ICU patients with organ failure. This study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE). ⋯ We found moderate to high probabilities of harm with high protein doses compared with usual protein in ICU patients for the primary and secondary outcomes. We found suggestions of heterogeneity in treatment effects with worse outcomes in participants randomised to high protein doses with renal dysfunction or acute kidney injury and greater illness severity at baseline.
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Editorial Review
Helping clinicians debrief themselves: a simple how-to guide.
The operating theatre is a dynamic and challenging environment where effective teamwork is essential. Routine clinical debriefings, which involve brief reflections on collaboration to identify successes and areas for improvement, have proved to enhance teamwork, particularly in the operating theatre. However, barriers such as time constraints, conflicting priorities, and a lack of standardised debriefing processes hinder their regular use. Implementation of TALK©, a voluntary self-debriefing method, showed significant improvements in debriefing performance and integration of debriefing into routine practice, although long-term consistency remains a challenge.
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Multicenter Study Observational Study
Effect of perioperative blood transfusion on preoperative haemoglobin levels as a risk factor for long-term outcomes in patients undergoing major noncardiac surgery: a prospective multicentre observational study.
Preoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes. ⋯ Preoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.