Journal of perioperative practice
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Hip fracture is a major cause of morbidity, mortality and loss of independence for the elderly. Surgical fixation of the fractured hip remains the standard of care to allow for early mobilisation and a return to independence. ⋯ The altered physiological state of the older person, often coupled with significant comorbidity, can present challenges for the anaesthetist, the surgeon and the rest of the perioperative team. This article provides an evidence-based review of the important perioperative factors associated with hip fractures in the older person and their management.
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Femoral nerve blocks and indeed all peripheral nerve blocks have become a popular, safe and effective method of providing postoperative analgesia. The advantages of a femoral nerve block for lower limb surgery include good postoperative analgesia, a reduction in the need for opioids (thus reducing the associated complications of opioids such as nausea, vomiting, itching and confusion (Allen et al 1998, Wang et al 2002)) and the potential for earlier mobilisation and discharge from the hospital (Wang et al 2002, Ilfeld et al 2008).
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Cleft lip and palate is one of the most common craniofacial anomalies. The surgery is not performed usually until the baby is three months of age. The anaesthesia technique is dependent on the difficulty of the airway. The anaesthetic practitioner therefore requires knowledge of the paediatric airway and of this particular anomaly and skill in the thorough preparation of the equipment used for intubating a baby for this procedure.
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Review
Acupressure and acupuncture in preventing and managing postoperative nausea and vomiting in adults.
This literature review sets out to investigate the effectiveness of acupressure and acupuncture in preventing and managing postoperative nausea and vomiting (PONV) in adult patients. PONV is problematic, affecting patient satisfaction, delayed discharge and even patient re-admission. Current treatment of PONV constitutes a variety of drug therapies, which are only partially effective. ⋯ Further investigation of the effectiveness of acupressure and acupuncture, combined with current drug therapies, using well designed and adequately powered studies is needed. Published studies predominantly examined the use of P6 as the pressure point. Further studies should examine other 'acupoint' sites, to ascertain whether these are effective dependent upon the operative site.
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Paravertebral blockade is a safe and effective technique for intraoperative and postoperative management of acute surgical pain. The block may be performed as a single injection or a catheter may be inserted to allow for the continuous or bolus administration of a long acting local anaesthetic. ⋯ There is little published about the care of patients receiving this form of analgesia. This article provides an overview of the technique of thoracic paravertebral analgesia, the choice of analgesics and side effects together with recommendations for patient care.