European journal of anaesthesiology
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Dexmedetomidine is a potent alpha-2-adrenergic agonist, more selective than clonidine, with widespread actions on the mammalian brain that include sedation, anaesthetic-sparing, analgesia and sympatholytic properties. A large body of recent work supports its favourable profile in improving outcome and long-term brain function in the critically ill. ⋯ Dexmedetomidine may also be a valuable adjuvant when regional anaesthesia is used. Future research should aim at establishing the risk/benefit ratio when used at the bedside.
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Emergency laparotomy is a common high-risk surgical procedure, but with few outcome data and few data on postoperative care. We aimed to observe mortality within a mixed general surgical population and to explore the potential impact of postoperative care on mortality. ⋯ Mortality after emergency laparotomy was high and very high in patients more than 80 years of age. The SMR was higher in the PACU-ward pathway compared to the ICU-HDU-ward pathway, suggesting room for improvement in the postoperative period.
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A Pre-operative Therapeutic Intensity Score (P-TIS) was developed to quantify intensity of pre-operative care. Its association with post-operative ICU admission was explored. ⋯ P-TIS quantifies the intensity of chronic and acute pre-operative care. Acute P-TIS predicted receipt of post-operative ICU care, especially in emergency surgery.
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While anaesthesiology is still perceived as a rather technical specialty, nontechnical skills of anaesthesiologists become increasingly important. In this context, we hypothesised that complaints and incident reports about anaesthesia service are often related to nontechnical skills. To test this hypothesis, we attributed complaints and incident reports to the seven roles of CanMEDS (Canadian Medical Educational Directives for Specialists), which are the role of 'medical expert', 'communicator', 'collaborator', 'health advocate', 'manager', 'scholar' and the role of 'professional'. ⋯ Our data suggest an increased importance of nontechnical skills in addition to medical expertise in anaesthesia service. We propose to take this aspect into consideration in postgraduate training programmes of anaesthesiologists to improve satisfaction of patients as well as colleagues.
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In this review, we shall consider the oral and intravenous fluid management of pregnant women during labour and operative delivery in the context of neuroaxial blockade. We shall also discuss the use of blood transfusion in the peripartum period, especially during postpartum haemorrhage. Current management of military casualties and major civilian trauma challenges traditional practices of blood product administration in massive haemorrhage and may radically modify transfusion practices during obstetric haemorrhage. Articles for inclusion were selected from medical databases, including MEDLINE and the Cochrane Library, and additional references were obtained from available relevant publications.