Anaesthesia
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Randomized Controlled Trial Clinical Trial
A programme for reducing smoking in pre-operative surgical patients: randomised controlled trial.
We assessed the efficacy of a comprehensive programme for stopping smoking in 210 smokers scheduled for surgery, before admission and 3 months after attending a pre-operative clinic. Participants were randomly allocated to receive an intervention incorporating nicotine replacement therapy for patients smoking more than 10 cigarettes per day ("dependent smokers"), or to a control group to receive usual care. Dependent smokers allocated to the intervention group were more likely to report abstinence before surgery than those allocated to receive usual-care (63 (73%) vs. 29 (56%), respectively; OR 2.2 (95% CI 1.0-4.8)), and 3 months after attendance (16 (18%) vs. 3 (5%), respectively; OR = 3.9 (95% CI 1.0-21.7).
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Multicenter Study
Cost effectiveness of drotrecogin alfa (activated) for the treatment of severe sepsis in the United Kingdom.
Drotrecogin alfa (activated) is licensed in Europe for the treatment of severe sepsis in patients with multiple organ failure. We constructed a model to assess the cost effectiveness of drotrecogin alfa (activated) from the perspective of the UK National Health Service when used in adult intensive care units. Patient outcomes from a 28-day international clinical trial (PROWESS) and a subsequent follow-up study (EVBI) were supplemented with UK data. ⋯ Applying the 28-day mortality outcomes of the PROWESS study, the model produced a cost per life year saved of 4608 UK pounds and cost per quality adjusted life year saved of 6679 UK pounds. Equivalent results using actual hospital outcomes were 7625 UK pounds per life year and 11,051 UK pounds per quality adjusted life year. Drotrecogin alfa (activated) appears cost effective in treating severe sepsis in UK intensive care units.
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Multicenter Study
Failed tracheal intubation in obstetrics: no more frequent but still managed badly.
In the South-West Thames region of the United Kingdom, during a 5-year period from 1999 to 2003, there were 20 failed tracheal intubations occurring in 4768 obstetric general anaesthetics (incidence 1 : 238). In half of the 16 cases for which the patient's notes could be examined there was a failure to follow an accepted protocol for failed tracheal intubation.
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The role of vascular tone in determining cerebral perfusion pressure is increasingly being appreciated. It has been suggested that zero flow pressure, the arterial pressure at which blood flow ceases, represents the effective downstream pressure of the cerebral circulation. Nitrous oxide is a cerebral vasodilator and may therefore decrease zero flow pressure and increase cerebral perfusion pressure. ⋯ We studied eight healthy volunteers at normocapnia and studied the effects of the inhalation of nitrous oxide 50% on estimated cerebral perfusion pressure and zero flow pressure using transcranial Doppler ultrasonography. We found that nitrous oxide 50% significantly increased estimated cerebral perfusion pressure (p = 0.03), whilst decreasing zero flow pressure (p = 0.01). These results suggest that the vasomotor effects of nitrous oxide predominate in determining the effective downstream pressure of the cerebral circulation in healthy individuals.
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A survey of the members of the Neuroanaesthesia Society of Great Britain and Ireland was conducted to examine issues arising from the management of long cases. Replies were received from 47% of neuroanaesthetists. ⋯ These pressures are likely to increase as the European Working Time Directive reduces the availability of trainees, and because of expansion in neurosurgery and neuroradiology. Similar concerns are likely to extend into other anaesthetic specialties with long-duration cases and may apply to our surgical colleagues.