European journal of anaesthesiology
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The anaesthesia workforce in Europe is understaffed and may not meet the growing demands of surgery. In many European countries where responsibilities can be identified and a varying degree of task substitution occurs, the anaesthesia service is provided by a team of physician and nonphysician anaesthesia members. This study assesses the availability, as well as the roles and functions, of nonphysician anaesthesia team members in European countries. ⋯ The present study demonstrated the heterogeneity and variety of anaesthesia practices throughout Europe. Standardisation of the training and practice of European nurse anaesthetists is desirable for patient safety and quality of care if they seek to work in more than one European country. Those countries that anticipate a shortfall in the supply of anaesthesiologists should examine working models from other countries that currently work with fewer physicians and more nurse anaesthetists.
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Randomized Controlled Trial Multicenter Study
Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients.
To examine the kinetics of volume loading with crystalloid and colloid infusions in critically ill patients after major surgery, using the pulse contour cardiac output (PiCCO) monitoring technique. ⋯ In postoperative hypovolaemic patients, lactated Ringer's solution can significantly improve haemodynamics at the end of volume loading, but this effect completely disappears at 120 min. Ten millilitres per kilogram of colloid bolus (especially HES) improved the haemodynamics at 120 min; however, this was by only 5-25% compared with baseline. The colloids caused significantly larger AUCs than lactated Ringer's solution, but only in the cardiac index, GEDVI and DO2I, plus human albumin in the SVV.
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Randomized Controlled Trial
Deep anaesthesia reduces postoperative analgesic requirements after major urological procedures.
There is evidence from previous studies that deeper anaesthetic levels reduce postoperative pain along with analgesic requirements. The aim of this study was to confirm this observation during major urological procedures under sevoflurane anaesthesia. ⋯ The results show that intraoperative deep anaesthetic levels during major urological procedures, achieved with high sevoflurane concentrations, lead to reduced postoperative analgesic requirements.
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Nonsteroidal anti-inflammatory drugs have peripheral analgesic effects. We compared the efficacy of peritonsillar infiltration versus intravenous (i.v.) lornoxicam on pain relief after tonsillectomy in adults. ⋯ Peritonsillar infiltration or i.v. lornoxicam enhanced postoperative analgesia after tonsillectomy in adults. However, the analgesic efficacy of locally applied lornoxicam is not superior to the i.v. administration.
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One approach to clinical decision-making requires the integration of the best available research evidence with individual clinical expertise and patient values, and is known as evidence-based medicine (EBM). In clinical decision-making with the current best evidence, systematic reviews have an important role. This review article covers the basic principles of systematic reviews and meta-analyses, and their role in the process of evidence-based decision-making. ⋯ The relevant steps in writing a systematic review from the formulation of an initial research question to sensitivity analyses in conjunction with the combined analysis of the pooled data are described. Important issues that need to be considered when appraising a systematic review or meta-analysis are outlined. Some of the terms that are used in the reporting of systematic reviews and meta-analyses, such as relative risk, confidence interval, Forest plot or L'Abbé plot, will be introduced and explained.