British journal of anaesthesia
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Multicenter Study Observational Study
Chronotropic incompetence and myocardial injury after noncardiac surgery: planned secondary analysis of a prospective observational international cohort study.
Physiological measures of heart failure are common in surgical patients, despite the absence of a diagnosis. Heart rate (HR) increases during exercise are frequently blunted in heart failure (termed chronotropic incompetence), which primarily reflects beta-adrenoreceptor dysfunction. We examined whether chronotropic incompetence was associated with myocardial injury after noncardiac surgery. ⋯ Chronotropic incompetence is common in surgical patients. In contrast to parasympathetic dysfunction which was associated with myocardial injury, preoperative chronotropic incompetence (suggestive of sympathetic dysfunction) was not associated with postoperative myocardial injury.
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Randomized Controlled Trial
Knowledge retention after simulated crisis: importance of independent practice and simulated mortality.
Simulation is an important component of postgraduate medical education, but optimal parameters for simulation are not known. Managing simulations independently and allowing simulated morbidity and mortality have been shown to improve follow-up performance in simulation. We hypothesised that allowing simulated mortality improves performance in follow-up simulations more than independent practice. ⋯ Independence and the potential for simulated mortality have a greater impact on performance in follow-up simulations when combined than either factor alone.
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Around 10-15% of the in-patient population carry unsubstantiated 'penicillin allergy' labels, the majority incorrect when tested. These labels are associated with harm from use of broad-spectrum non-penicillin antibiotics. Current testing guidelines incorporate both skin and challenge tests; this is prohibitively expensive and time-consuming to deliver on a large scale. We aimed to establish the feasibility of a rapid access de-labelling pathway for surgical patients, using direct oral challenge. ⋯ ClinicalTrials.gov: AN17/92982.
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Xenon is a noble gas with neuroprotective properties that can improve short and long-term outcomes in young adult mice after controlled cortical impact. This follow-up study investigates the effects of xenon on very long-term outcomes and survival. ⋯ Xenon treatment after TBI results in very long-term improvements in clinically relevant outcomes and survival. Our findings support the idea that xenon treatment shortly after TBI may have long-term benefits in the treatment of brain trauma patients.