Anaesthesia
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Review Meta Analysis
The role of prophylactic fresh frozen plasma in decreasing blood loss and correcting coagulopathy in cardiac surgery. A systematic review.
Summary Fresh frozen plasma is commonly used in cardiac surgery in an attempt to replace clotting factors and to decrease bleeding. Despite this, there has been no previous review of the available literature to support this practice. The aim of this review was to study the effect of prophylactic peri-operative transfusion of fresh frozen plasma on bleeding and coagulopathy in patients undergoing cardiac surgery. ⋯ The overall quality of the studies was poor due to small patient numbers and lack of allocation concealment. There was no evidence that the prophylactic use of fresh frozen plasma affected peri-operative blood loss in cardiac surgery. There was some evidence that it may improve platelet count and fibrinogen concentration.
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Randomized Controlled Trial Clinical Trial
The effects of intrathecal diamorphine on gastric emptying after elective Caesarean section.
This study investigated whether intrathecal diamorphine affects gastric emptying following elective Caesarean section. Forty women were randomly allocated to receive either diamorphine 300 microg or 0.9% saline as part of a standard spinal anaesthetic. Gastric emptying was measured in the immediate postoperative period using paracetamol absorption. ⋯ The time to maximum concentration (Tmax) was statistically longer in the diamorphine group (control 41.8, SD 20.8 min; diamorphine 72.6 SD 41.9 min; p < 0.01). During the 2-h study period, mean morphine consumption via a patient controlled analgesia device was significantly higher in the control group (control 9.3, SD 3.6 mg; diamorphine 2.1, SD 2.1 mg; p < 0.01). We conclude that intrathecal diamorphine may contribute to the delay in gastric emptying that occurs immediately following elective spinal Caesarean section.
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We report the pre-operative preparation and anaesthetic management for resection of an intracerebral tumour during awake craniotomy in a 9-year-old boy. We believe this is the youngest patient reported to have undergone this procedure. ⋯ We conclude that the procedure can be performed safely and that it seems unacceptable to uphold an age restriction. We believe that it is the individual level of development of the child that determines suitability for this type of surgery.
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The Theory of Planned Behaviour has been used to investigate the likelihood that anaesthetists will routinely perform three violations of safety guidelines. The three violations were: failing to visit patients before surgery, failure to perform pre-anaesthetic equipment checks and the silencing of alarms during anaesthesia. These suggested violations arose from discussions with the Medical Defence Union. ⋯ The next most influential factor is their personal norms, i.e. beliefs that the individual has about whether the violation is really right or wrong, followed by behavioural beliefs, i.e. beliefs about the consequences of performing the violation, and control beliefs, i.e. beliefs about how much control they have over performing the violation. The results show that the more intense the anaesthetists' belief that the violations were important, the less likely they were to violate, except for the case of alarm silencing. This result suggests that there may be a basic lack of confidence in the reliability of audible alarms that undermines their utility.