Anaesthesia
-
Comparative Study
The TEG vs the ROTEM thromboelastography/thromboelastometry systems.
We have evaluated the TEG thromboelastograph and the ROTEM thromboelastometer, two point-of-care devices that measure blood coagulation. During a one-week period, seven consultant anaesthetists, one consultant haematologist, one associate specialist anaesthetist and two senior trainee anaesthetists were trained by the manufacturers and set up, calibrated and used both systems, after which their views were obtained and specific technical/support information was sought from the manufacturers using a questionnaire. Although the devices shared common features, they differed in complexity and aspects of ease of use, and in their purchase and running costs.
-
Randomized Controlled Trial
The impact of trained assistance on error rates in anaesthesia: a simulation-based randomised controlled trial.
Trained assistance for the anaesthetist appears likely to improve safety in anaesthesia. However, there are few objective data to support this assumption, and the requirement for a trained assistant is not universally enforced. We applied a simulation-based model developed in previous work to test the hypothesis that the presence of a trained assistant reduces error in anaesthesia. ⋯ The mean (SD) error rate per scenario was 4.75 (2.9). There were significantly fewer errors in the technician group than the nurse group (33 vs 62, p = 0.01) and this difference remained significant when errors were weighted for severity. This provides objective evidence supporting the requirement for trained assistance to the anaesthetist, and furthermore, demonstrates that a simulation-based model can provide rigorous evidence on safety interventions in anaesthesia.
-
Letter Case Reports
Persistent pain relief following interscalene analgesia for cancer pain.
-
Randomized Controlled Trial Multicenter Study
Ondansetron has similar clinical efficacy against both nausea and vomiting.
Ondansetron is widely believed to prevent postoperative vomiting more effectively than nausea. We analysed data from 5161 patients undergoing general anaesthesia who were randomly stratified to receive a combination of six interventions, one of which was 4 mg ondansetron vs placebo. For the purpose of this study a 20% difference in the relative risks for the two outcomes was considered clinically relevant. ⋯ Vomiting was reduced from 17% (441/2585) to 11% (293/2576), corresponding to a relative risk of 0.67, or a relative risk reduction of 33%. The relative risks of 0.67 and 0.74 were clinically similar and the difference between them did not reach statistical significance. We thus conclude that ondansetron prevents postoperative nausea and postoperative vomiting equally well.
-
Randomized Controlled Trial Comparative Study
Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine.
The present study was conducted with the aims of comparing intravenous tramadol 1, 2 and 3 mg.kg(-1) with pethidine 0.5 mg.kg(-1) for prophylaxis of postanaesthetic shivering and to find a dose of tramadol that could provide the dual advantage of antishivering and analgesic effect in the postoperative period. The study included 165 patients, randomly allocated to five groups of 33 each. ⋯ All three doses of tramadol were effective and comparable to pethidine in preventing postanaesthetic shivering. Tramadol 2 mg.kg(-1) had the best combination of antishivering and analgesic efficacy without excessive sedation and thus appeared to be a good choice to be administered at the time of wound closure to provide antishivering effect and analgesia without significant side effects in the postoperative period.