British journal of anaesthesia
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Multicenter Study
Effects of hydroxyethyl starch administration on renal function in critically ill patients.
The influence of hydroxyethyl starch (HES) solutions on renal function is controversial. We investigated the effect of HES administration on renal function in critically ill patients enrolled in a large multicentre observational European study. ⋯ In this observational study, haematological cancer, the presence of sepsis, cardiovascular failure, and baseline renal function as assessed by the SOFA score were independent risk factors for the subsequent need for RRT in the ICU. The administration of HES had no influence on renal function or the need for RRT in the ICU.
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Multicenter Study Controlled Clinical Trial
Influence of acute normovolaemic haemodilution on the dose-response relationship, time-course of action and pharmacokinetics of rocuronium bromide.
Acute normovolaemic haemodilution (ANH) is an effective strategy for avoiding or reducing allogeneic blood transfusion. We aimed to study its effect on the pharmacological profile of rocuronium. ⋯ ANH resulted in prolongation of rocuronium time-course of action, thus careful monitoring of neuromuscular block is recommended in patients who undergo ANH.
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Multicenter Study
A Scottish National Prospective Study of airway management skills in new-start SHOs.
There is increasing concern about the ability of junior anaesthetists to manage the airway correctly and alarm that this may lead to adverse events. ⋯ We recommend that facemask anaesthesia is given a high priority in the formative months and that a target number of intubations should be carried out before providing anaesthesia without direct supervision.
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Multicenter Study
Perioperative fluid therapy in children: a survey of current prescribing practice.
Fluid therapy in children may be associated with iatrogenic hyponatraemia. We surveyed anaesthetists' current fluid prescribing practice during the perioperative period, departmental fluid protocols and awareness of the concerns of the Royal College of Paediatrics and Child Health (RCPCH) about the use of dextrose 4%/saline 0.18% in children. ⋯ The prescription of hypotonic dextrose saline solutions by anaesthetists may be putting children at risk from iatrogenic hyponatraemia. Departmental protocols for perioperative fluid prescription in children are uncommon. We suggest that national guidance is required.
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A 45% complication rate and a mortality of 20% were reported previously in patients undergoing non-cardiac surgery after coronary artery stenting. Discontinuation of antiplatelet drugs appeared to be of major influence on outcome. Therefore we undertook a prospective, observational multicentre study with predefined heparin therapy and antiplatelet medication in patients undergoing non-cardiac procedures after coronary artery stenting. ⋯ Despite heparin and despite having all patients on intensive/intermediate care units, cardiac events are the major cause for new perioperative morbidity/mortality in patients undergoing non-cardiac surgery after coronary artery stenting. The complication rate exceeds the re-occlusion rate of stents in patients without surgery (usually <1% annually). Patients with coronary artery stenting less than 35 days before surgery are at the greatest risk.