Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2011
Case ReportsThe influence of objective prognostic information on the likelihood of informed consent for decompressive craniectomy: a study of Australian anaesthetists.
The aim of this study was to assess the influence of detailed prognostic information on the likelihood of informed consent for decompressive craniectomy for severe traumatic brain injury. The study was a simulation exercise, asking anaesthetists to give opinions as if they themselves were the injured party. Anaesthetists were chosen as they represent a distinct group likely to be familiar with the procedure and the decision-making process, but not necessarily aware of the longer-term outcomes. ⋯ The participants' preferences to consent to the procedure changed after being informed of the predicted risks of unfavourable outcomes (P values < 0.01). The changes in attitude appeared to be independent of age group, amount of experience in caring for similar patients and religious background. These findings suggest that access to objective information on risks of unfavourable outcomes may influence opinions in relation to consent for decompressive craniectomy for traumatic brain injury.
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Anaesth Intensive Care · Jul 2011
Historical ArticleChloroform for the King? Joseph Clover, Henry Thompson and the King of the Belgians.
In May 1863 the British surgeon, Henry Thompson, departed for Belgium to attend Leopold, King of the Belgians. The King was in agony: he had suffered with bladder stones for months and multiple procedures, without anaesthesia, had failed to relieve his symptoms. Henry Thompson was therefore consulted about the possibility of operating under the influence of chloroform. ⋯ History records that the successful operation was performed under chloroform anaesthesia administered by Joseph Clover. But a letter from Henry Thompson, discovered in Clover's personal papers, raises a number of questions about this operation. This was the procedure that made Henry Thompson rich and famous, but was it actually performed under anaesthesia? And if not, why not?
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Anaesth Intensive Care · Jul 2011
Case ReportsCalcitonin for acute neuropathic pain associated with spinal cord injury.
Neuropathic pain associated with spinal cord injury is caused by complex neural mechanisms and is often refractory to standard therapy. Salmon calcitonin was an effective treatment for neuropathic symptoms in this case series of three patients with recent spinal cord injury. ⋯ Calcitonin is thought to exert its effect by modulation of the serotonergic system and is generally well tolerated and convenient to administer. This underutilised drug may be a very useful adjuvant for neuropathic pain associated with spinal cord injury.
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Anaesth Intensive Care · Jul 2011
Randomized Controlled TrialOndansetron does not modify emergence agitation in children.
In this prospective, placebo-controlled study, we evaluated the effect of prophylactic ondansetron therapy on emergence agitation of children who underwent minor surgery below the umbilicus. Seventy children aged one to six years and American Society of Anesthesiologists physical status I were studied. Children were premedicated with midazolam rectally and were randomly assigned to receive either ondansetron (Group O) or placebo (Group P) in combination with caudal anaesthesia. ⋯ Ready time for discharge was similar between the groups. Agitated patients had significantly increased ready time for discharge compared to non-agitated patients (P = 0.001). Prophylactic intravenous ondansetron administration does not reduce emergence agitation comparing to placebo after sevoflurane anaesthesia.