Anaesthesia
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The effects of prescribing guidelines for analgesia were assessed by auditing prescriptions for opioids before and after the introduction of hospital prescribing guidelines. Opioid prescriptions were collected by the pharmacy department over a 2-week period in November 1994 and repeated in November 1995. ⋯ There was a statistically significant decrease in the number of prescriptions that were inadequate for both dose and frequency according to both the British National Formulary recommendations (18-3%; p < 0.001) and our Acute Pain Service guidelines (36-17%; p = 0.001). The use of accessible prescribing guidelines promotes demonstrable improvements in opioid prescribing.
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Clinical Trial Controlled Clinical Trial
Gastric intramucosal pH and blood lactate in severe sepsis.
We prospectively investigated the effect of conventional resuscitation on gastric intramucosal pH and lactate over 5 days in a group of patients with newly diagnosed severe sepsis. Lactate and gastric intramucosal pH were measured on entry into the study, as soon as resuscitation end points were met, eight hourly for 48 h and daily for 5 days. Sixteen of 18 patients had a low gastric intramucosal pH (mean (SD) 7.17 (0.12)) at the time of diagnosis of severe sepsis. ⋯ At 48 h lactate was lower in survivors (p < 0.01) and gastric intramucosal pH higher in survivors (p < 0.05). Receiver operating characteristic curves at this time indicate that lactate is a better predictor of survival. It is likely, based on the inability of gastric intramucosal pH to distinguish survivors from nonsurvivors until 48 h, that it is not possible to use this measurement to guide resuscitation in patients who are severely ill and who have gastric intramucosal acidosis.
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Randomized Controlled Trial Clinical Trial
Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability.
In a double-blind, placebo-controlled study we investigated the effect of a single pre-induction intravenous dose of dexmedetomidine 2 micrograms.kg-1 on anaesthetic requirements and peri-operative haemodynamic stability in 50 patients undergoing minor orthopaedic and general surgery. Patients were anaesthetised with nitrous oxide/oxygen/fentanyl, supplemented if necessary with isoflurane. ⋯ The haemodynamic response to tracheal intubation and extubation was reduced in the dexmedetomidine group as was intra-operative heart rate variability; postoperative analgesic and anti-emetic requirements and peri-operative serum catecholamine concentrations were lower in the dexmedetomidine group. Hypotension and bradycardia occurred more frequently after dexmedetomidine.