Anaesthesia
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Threshold systolic arterial pressure alarms often use pre-operative values as a guide for intra-operative values. Recently, two systems (normalisation and principal component analysis) have been described that use the 'current' systolic arterial pressure and the change in systolic arterial pressure over a preceding time interval to generate an alarm based on units of standard deviation. ⋯ Systolic blood pressure data, collected from 10 patients (a total of 2177 min at 100 Hz), were cleaned and submitted to analysis using threshold alarms, normalisation and principal component analysis. With the threshold alarms set at 100 mmHg (low) and 140 mmHg (high), and a 5-min window, the alarms were activated for 557 min; using statistics-based thresholds the alarms were activated for 169 min (normalisation) and 155 min (principal component analysis), a reduction of approximately 70-72%.
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Gathering evidence from animal experiments, an editorial in this journal and published human case reports culminated in the Association of Anaesthetists of Great Britain and Ireland recommending in August 2007 that lipid emulsion be immediately available to all patients given potentially cardiotoxic doses of local anaesthetic drugs. This development offered an opportunity to track the adoption of an innovation by anaesthetists in the UK and to gauge the effects of guidelines. Two surveys, each of 66 NHS hospitals delivering acute care within London and its penumbra, examined the adoption of lipid emulsion therapy. ⋯ At the end of 2007, there remained a small number of hospitals that had yet to adopt lipid rescue. Lipid rescue's adoption by anaesthetists in the UK offers a rare example of swift uptake of an innovation. National guidelines accelerated the adoption of innovation by some hospitals.
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Practice Guideline
Suspected anaphylactic reactions associated with anaesthesia.
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Comment Letter Multicenter Study
Survey of combined regional blocks and general anaesthesia.
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Words with negative emotional content such as pain or itch may enhance perception of these symptoms. We assessed open and direct questioning for symptoms in 100 women following Caesarean section. Of the 65 women reporting pain, 25 (39%) did so only when questioned specifically. ⋯ Most women with bothersome pain or who request analgesia reveal this with open questioning. However, specific questioning is required to elicit pain in all patients. Most patients are bothered by pain at pain scores >or= 6, while those with scores < 6 are unlikely to request additional analgesia.