British journal of anaesthesia
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Traditionally, programmes for specialist education in anaesthesia and intensive care have been based on lists of attributes such as skills and knowledge. However, modern research in the science of teaching has shown that competence development is linked to changes in the way professionals understand their work. The aim of this study was to define the different ways in which trainee anaesthetists understand their work. ⋯ Trainee anaesthetists understand their work in different ways. The trainee's understanding affects both his/her way of performing work tasks and how he/she develops new competences. A major task for teachers of anaesthesia is to create learning situations whereby trainees can focus on new aspects of their professional work and thus develop new ways of understanding it.
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Comparative Study
Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective.
Spinal cord stimulation (SCS) has been used since 1967 for the treatment of patients with chronic pain. However, long-term effects of this treatment have not been reported. The present study investigated the long-term effects of cervical and lumbar SCS in patients with complex regional pain syndrome type I. ⋯ SCS reduced the pain intensity and improves health status in the majority of the CRPS I patients in this study. There was no difference in pain relief and complications between cervical and lumbar SCS.
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Randomized Controlled Trial Clinical Trial
Double-blind randomized controlled trial of caudal versus intravenous S(+)-ketamine for supplementation of caudal analgesia in children.
The postoperative analgesic efficacy of S(+)-ketamine after caudal or i.v. administration following sub-umbilical surgery in children was studied to investigate its principal site of analgesic action. ⋯ We have demonstrated that the addition of caudal S(+)-ketamine to bupivacaine prolongs the duration of postoperative analgesia. However, the same dose of i.v. S(+)-ketamine combined with a plain bupivacaine caudal provides no better analgesia than caudal bupivacaine alone, indicating that the principal analgesic effect of caudal S(+)-ketamine results from a local neuroaxial rather than a systemic effect.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia for carotid endarterectomy: comparison of hypnotic- and opioid-based techniques.
Although the synergistic interaction between hypnotics and opioids for total i.v. anaesthesia has been repeatedly demonstrated, questions about different dose combinations of hypnotics and opioids remain. The optimal combination would be based on maximal synergy, using the lowest dose of both drugs and having the lowest incidence of side-effects. ⋯ Maintenance of anaesthesia predominantly with propofol and a low dose of remifentanil, both administered using TCI, is associated with greater stability in perioperative haemodynamics than anaesthesia predominantly with remifentanil alone. Postoperative pain was identical in both groups of patients who underwent relatively short duration, and relatively painless surgery.
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Randomized Controlled Trial Clinical Trial
Concentration of rocuronium in cerebrospinal fluid of patients undergoing cerebral aneurysm clipping.
This study assessed the concentration of rocuronium in the cerebrospinal fluid (CSF) of patients undergoing cerebral aneurysm clipping, and investigated whether the mode of administration (single bolus vs continuous infusion) influenced the CSF concentration. ⋯ This study demonstrated that rocuronium, normally not considered to cross the blood-brain barrier, is regularly found in the CSF of patients undergoing cerebral clipping; continuous infusion of the drug led to higher plasma and CSF concentrations than after a single bolus dose.