Anaesthesia and intensive care
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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.
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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
Randomized Controlled Trial Comparative Study Clinical TrialComparison of total intravenous, balanced inhalational and combined intravenous-inhalational anaesthesia for tympanoplasty, septorhinoplasty and adenotonsillectomy.
Two hundred and thirty-five consecutive Saudi patients aged between two and fifty-three years undergoing elective tympanoplasty (n = 32), septorhinoplasty (n = 68) or adenotonsillectomy (n = 135) were studied. They were randomized to receive either a total intravenous anaesthetic (10 ears, 23 noses, 44 throats) consisting of propofol for induction of anaesthesia followed by a propofol infusion, a combined intravenous-inhalational anaesthetic (11 ears, 22 noses, 46 throats) consisting of the above with isoflurane in oxygen-enriched air, or a balanced inhalational anaesthetic (11 ears, 23 noses, 45 throats) consisting of thiopentone for induction of anaesthesia and oxygen in nitrous oxide with isoflurane for maintenance. During tympanoplasty, all three anaesthetic techniques produced stable heart rates and arterial pressures. ⋯ During adenotonsillectomy, total intravenous anaesthesia produced a rise in both heart rate and blood pressure, the combined technique produced a rise in heart rate alone while balanced anaesthesia produced haemodynamic stability. Postoperatively, vomiting, pain scores and analgesic requirements were similar following all three types of anaesthetic within each surgical site subgroup. Our findings support the choice of balanced inhalational anaesthesia for all three types of ENT surgery and, where cost and facilities permit, total intravenous anaesthesia for tympanoplasty and combined intravenous-inhalational anaesthesia for septorhinoplasty.