Anaesthesia
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Antiphospholipid syndrome is a paradoxical disease state with in vitro prolongation of activated partial thromboplastin time and a strong predilection for in vivo thrombosis. The syndrome can be associated with systemic lupus erythematosus or lupus-like diseases or may be primary, presenting with thrombotic phenomena in young patients with no risk factors for thrombosis. We present two cases seen in two different settings in the hospital.
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A postal survey was performed to investigate whether the National Confidential Enquiry into Perioperative Deaths (NCEPOD) had influenced clinical practice. A short questionnaire was sent to 100 consultant anaesthetists from England, Wales and Northern Ireland. There was a 72% response rate. ⋯ Some individuals had tried and failed to establish improvements. Nearly 80% perceived current threats to standards of care that NCEPOD might investigate in the future. The replies indicated that NCEPOD is perceived by clinicians as influencing clinical practice and standards of care.
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Music in theatre: not so harmonious. A survey of attitudes to music played in the operating theatre.
Music played to staff in the operating theatre is thought to improve surgeons' concentration but its effects on other theatre staff are unknown. We surveyed 200 anaesthetists to determine the prevalence of music playing in the operating theatre and anaesthetists' attitudes to it. ⋯ Around 26% of the sample felt that music reduced their vigilance and impaired their communication with other staff while 11.5% felt that music might distract their attention from alarms. Fifty-one per cent felt that music was distracting when a problem was encountered during the anaesthetic.
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Randomized Controlled Trial Clinical Trial
The minimum effective doses of pethidine and doxapram in the treatment of post-anaesthetic shivering.
This study was designed to find the minimum effective doses of doxapram and pethidine to stop post-anaesthetic shivering. Two hundred and twenty healthy patients who shivered following routine surgery were allocated randomly to receive one of 10 doses of doxapram (0.18, 0.23, 0.29, 0.35, 0.41, 0.47, 0.7, 0.93, 1.17 and 1.4 mg.kg-1), one of five doses of pethidine (0.12, 0.18, 0.23, 0.29 and 0.35 mg.kg-1) or saline. Probit analysis demonstrated that the number of patients who stopped shivering with doxapram was independent of the amount of drug given in this dose range. ⋯ We conclude that 0.35 mg.kg-1 of pethidine is the minimum dose required to treat post-anaesthetic shivering effectively. We also conclude that 0.18 mg.kg-1 of doxapram is as effective as 1.4 mg.kg-1 in the treatment of post-anaesthetic shivering. Further study is required to find the minimum effective dose of doxapram.