European journal of anaesthesiology
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Sometimes progress is hard to see, when looking at the big picture, because there is very little of it. But sometimes progress is hard to see because the big picture is out of focus. When perioperative deaths ascribed to anaesthesia are in the order of 1 in 20,000 operations and even changes in major morbidity require massive sample sizes to detect, neuroanaesthesia's most emphatic yardstick of progress is too crude to measure advances that have occurred over the most recent decade. ⋯ Of course, this measurement problem plagues anaesthesiology generally, and we need to attend to it in general. Meanwhile, saying where we are relative to the recent past and the near future involves a lot of guesswork. What follows is my guess-work about progress in neurosurgical anaesthesiology.
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Case Reports
Paradoxical air embolism during orthoptic liver transplantation: diagnosis by transoesophageal echocardiography.
We describe a case of paradoxical air embolism during orthotopic liver transplantation, early diagnosis, using intra-operative transoesophageal echocardiography after a circulatory failure, allowed early management by hyperbaric oxygen therapy.
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Randomized Controlled Trial Clinical Trial
Dimenhydrinate for prevention of post-operative nausea and vomiting in female in-patients.
Dimenhydrinate is an inexpensive antihistaminic drug, that is frequently used as an anti-emetic during anaesthesia. The popularity of the drug is contrasted by the lack of modern studies concerning its efficacy in reducing the incidence of post-operative nausea and vomiting. Thus, dimenhydrinate was compared with placebo in this prospective, randomized, double-blind study. ⋯ No relevant side effects were observed. Intra-operative dimenhydrinate, followed by three further administrations after surgery, reduces the incidence and the severity of post-operative nausea and vomiting without side effects. However, there still remained an unacceptable high number of patients who were not prevented completely from experiencing post-operative nausea and vomiting.
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A review was undertaken of all 190 patients who were referred over 7 years, from 1991 to 1997 inclusive, for an epidural blood patch as a treatment for headache after dural puncture. The patterns of referral and symptoms, the distributions of age and gender and the effectiveness of the blood patch were examined. Most of the referrals (n = 153) were after deliberate diagnostic dural puncture in neurology and neuroradiology, with a minority (n = 28) used for anaesthesia and obstetrics, which were mostly inadvertent. ⋯ Epidural blood patches are effective in treating headache after dural puncture, but less successful than is commonly believed, especially after inadvertent dural taps. A relapse after treatment does not always require a second patch. Specialities other than anaesthesia seemed reluctant to accept the benefits in both cost and comfort of using needles of improved design for dural puncture.