Anaesthesia and intensive care
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Anaesthetists work as part of a process and deal with complex situations in their daily work. Considerable effort is put into training anaesthetists, but little has been done either in research or improving awareness of the intangible components of the anaesthesia system that affect safety, such as decision-making. The purpose of this article is to apply the principles of decision-making to anaesthesia practice.
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Comparative Study Clinical TrialSingle-dose prophylaxis for postoperative nausea and vomiting after major abdominal surgery: ondansetron versus droperidol.
The new antiemetic ondansetron is effective for the prophylaxis and treatment of postoperative nausea and vomiting (PONV), but has been subject to limited comparative evaluation in surgical inpatients. Two hundred and seventy women having abdominal gynaecological surgery were investigated for 24 hours postoperatively in a randomized, double-blind, placebo-controlled study of intraoperative intravenous ondansetron 8 mg (n = 83), droperidol 2.5 mg (n = 89) or saline placebo (n = 87). Patients receiving either ondansetron or droperidol remained likely to vomit, although the incidence was significantly reduced compared with placebo (72% and 83% versus 91%, P < 0.01). ⋯ Ondansetron reduced the risk of experiencing nausea after six hours postoperatively and the risk of vomiting, with respect to the total number of episodes, in the first 24 hours. It was no better than droperidol, however, in reducing the incidence of vomiting or the need for antiemetic treatment during the first postoperative day, whether or not patients had a past history of PONV. It was no better than droperidol, however, in reducing the incidence of vomiting or the need for antiemetic treatment during the first postoperative day, whether or not patients had a past history of PONV.
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Anaesth Intensive Care · Oct 1995
Meta AnalysisA meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica.
The efficacy of epidural corticosteroids in the treatment of sciatica was investigated by meta-analysis of all randomized controlled trials. Eleven suitable trials of good quality were identified involving a total of 907 patients. The use of epidural (caudal or lumbar) steroid in the short-term (up to 60 days) increased the odds ratio (OR) of pain relief ( > 75% improvement) to 2.61 (95% CI 1.90-3.77) when compared with placebo. ⋯ Adverse events included dural tap (2.5%), transient headache (2.3%) and a transient increase in pain (1.9%). There were no reported longterm adverse events. In conclusion we present quantitative evidence from meta-analysis of pooled data from randomized trials that epidural administration of corticosteroids is effective in the management of lumbosacral radicular pain.
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Anaesth Intensive Care · Oct 1995
Randomized Controlled Trial Clinical TrialEffect of propofol infusion on the endocrine response to cardiac surgery.
The effect of propofol infusion on the stress response was studied in patients undergoing coronary artery bypass graft (CABG). Ten patients received propofol infusion during cardiopulmonary bypass (CPB) and ten controls received diazepam. ⋯ There was a significant reduction in all three hormones (P < 0.05) in the study group. In addition, the amount of sodium nitroprusside used during CPB was significantly reduced (P < 0.05).
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Anaesth Intensive Care · Oct 1995
The perioperative system: a new approach to managing elective surgery.
A Perioperative Service has recently been introduced at liverpool hospital, a 460-bed university teaching hospital. This provides a co-ordinated system for managing all elective surgical patients from the time an admission booked until hospital discharge. This paper describes the patient assessment, structure and staff requirements, benefits of and problems encountered with this service. ⋯ There has been a reduction in the areas of cancellations due to unavailability of beds, inappropriate preparation of patients, and non-attendance of patients for booked procedures. Patient acceptance is high. The existence of a perioperative system facilitates the planning and management of elective surgery with maximum quality and efficiency.