European journal of anaesthesiology
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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.
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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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Comparative Study
Role of nuclear factor-κB in volatile anaesthetic preconditioning with sevoflurane during myocardial ischaemia/reperfusion.
Anaesthetic preconditioning (APC) protects against myocardial ischaemia/reperfusion injury. Nuclear factor-kappaB (NF-kappaB) has been implicated in APC-induced myocardial protection in vitro. Our study tested the hypothesis that in-vivo APC with sevoflurane is triggered by NF-kappaB through downregulation of inflammatory mediators and upregulation of antiapoptosis factors to prevent myocardial injury during ischaemia/reperfusion. ⋯ APC with sevoflurane produced myocardial protection against ischaemia/reperfusion in vivo. NF-kappaB acted not only as a trigger but also as a mediator that played an important role in APC through upregulation of NF-kappaB and the antiapoptosis protein Bcl-2 during the preconditioning period and then through downregulation of the inflammatory proteins intercellular adhesion molecule-1 and tumour necrosis factor-alpha during reperfusion, ultimately decreasing caspase-3 expression and apoptosis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Bispectral index-controlled postoperative sedation in cardiac surgery patients: a comparative trial between closed loop and manual administration of propofol.
Postoperative cardiac surgery patients are usually sedated according to clinical sedation scores. Electrophysiological data derived from electroencephalography, such as the bispectral index (BIS), have been reported to assess and quantify the level of sedation, although experience in these patients is limited. In the current study, we evaluated a closed-loop system - closed-loop anaesthesia delivery system (CLADS) - for postoperative sedation after open heart surgery using BIS. ⋯ Closed-loop delivery of propofol to control BIS for postoperative sedation is feasible and efficient after cardiac surgery.