European journal of anaesthesiology
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Review Practice Guideline
Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.
This guideline aims to provide an overview of the present knowledge on aspects of perioperative fasting with assessment of the quality of the evidence. A systematic search was conducted in electronic databases to identify trials published between 1950 and late 2009 concerned with preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. One study on preoperative fasting which had not been included in previous reviews and a further 13 studies published since the most recent review were identified. ⋯ Breast milk is safe up to 4 h and other milks up to 6 h. Thereafter, clear fluids should be given as in adults. The guidelines also consider the safety and possible benefits of preoperative carbohydrates and offer advice on the postoperative resumption of oral intake.
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Randomized Controlled Trial
A randomised double-blind crossover trial of the potential analgesic effect of a transdermal nicotine patch in non-smokers based on objective and subjective assessment.
The results of studies of the analgesic effect of nicotine in humans are complex because these studies have included smokers with variable smoking histories. We investigated whether the use of a 17.5 mg transdermal nicotine (TDN) patch decreased the magnitude of pressure pain on the hands of healthy non-smoking volunteers. ⋯ The nicotine patch had no analgesic effect in non-smoking volunteers.
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Mechanical ventilation is a prerequisite for many surgical interventions. Furthermore, during states of severe gas exchange disturbance or impaired neurological conditions with the threat of aspiration or cardiovascular instability, it is a life-saving intervention on every ICU. ⋯ Although these pathophysiological changes may be of minor importance for the majority of ventilated patients in the operating room, these mechanisms may harm patients during surgical interventions with the need for one-lung ventilation or with underlying co-morbidities such as chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome (ARDS). This review provides an outline of the major components of the pathophysiological changes associated with general anaesthesia and describes the additional risks in patients with COPD and ARDS as common co-morbidities in every hospital.