European journal of anaesthesiology
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Multicenter Study
The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals.
Preoperative evaluation performed by anaesthesiologists primarily aims to estimate the risk of perioperative complications and to create opportunities to optimize the patients' condition before surgery. In this study an inventory was made of the current practice of preoperative evaluation in Dutch hospitals. It was estimated how many hospitals had implemented an outpatient preoperative evaluation clinic in 2004. Subsequently, current practice was compared with the results of a previous inventory (2000). It was also evaluated to what extent the guidelines of the Dutch Health Council and the Netherlands Society of Anaesthesiology were followed. ⋯ The Dutch guidelines on preoperative evaluation seem to have influenced current practice. An increase in the number of outpatient preoperative evaluation clinics was seen after the guidelines were published. The implementation of an outpatient preoperative clinic seems to warrant that anaesthesiologists are carrying out the activities prescribed by the guidelines. Most hospitals without a clinic aim to implement one in the future.
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Randomized Controlled Trial Comparative Study
Discomfort on injection: a comparison between two formulations of propofol.
A randomized double-blind controlled trial was performed to determine if there was a difference in discomfort on injection between two preparations of propofol. A long-chain triglyceride preparation (LCT-propofol (Fresenius)) was compared against a medium- and long-chain triglyceride preparation (MCT/LCT-propofol (BBraun)). ⋯ There is a significant decrease in the incidence of discomfort with MCT/LCT-propofol compared with LCT-propofol. This difference is more marked in subjects reporting severe discomfort.
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Randomized Controlled Trial Comparative Study
Doxapram and aminophylline on bispectral index under sevoflurane anaesthesia: a comparative study.
To evaluate and compare the effect of two clinically available central nervous system stimulants, namely doxapram and aminophylline on arousal from sevoflurane anaesthesia and bispectral index. ⋯ Intravenous administration of doxapram 1 mg kg(-1) or aminophylline 2 mg kg(-1) hastened the early recovery from sevoflurane anaesthesia. The arousal effect of aminophylline and doxapram appears to be similar.
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Subarachnoid haemorrhage due to rupture of cerebral aneurysms is a multisystem disease. Treatment of the condition in the past has relied on craniotomy and clipping of the aneurysm to prevent a recurrent haemorrhage. ⋯ Anaesthetists need to be familiar with this procedure and the management of potential complications. This review provides an overview such considerations.
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Derived parameters of the electroencephalogram and auditory evoked potentials can be used to determine depth of anaesthesia and sedation. However, it is not known whether any parameter can identify the occurrence of awareness in individual patients. We have compared the performance of bispectral index and a new composite index derived from auditory evoked potentials and the electroencephalogram (AAI 1.61) in predicting consciousness, explicit and implicit memory during moderate sedation with propofol. ⋯ Both bispectral index and AAI may be indices of depth of sedation rather than indicators of memory formation, which persists during propofol sedation even after loss of consciousness.