Anaesthesia
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Review Meta Analysis
Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis.
Intravenous magnesium has been reported to improve postoperative pain; however, the evidence is inconsistent. The objective of this quantitative systematic review is to evaluate whether or not the peri-operative administration of intravenous magnesium can reduce postoperative pain. ⋯ Numeric pain scores at rest and on movement at 24 h postoperatively were reduced by 4.2 (95% CI -6.3 to -2.1; p < 0.0001) and 9.2 (95% CI -16.1 to -2.3; p = 0.009) out of 100, respectively. We conclude that peri-operative intravenous magnesium reduces opioid consumption, and to a lesser extent, pain scores, in the first 24 h postoperatively, without any reported serious adverse effects.
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The care of sick children can be challenging for the anaesthetist who is only involved in the occasional care of paediatric patients. This paper outlines the care of medical and surgical paediatric emergencies for which an anaesthetist working at a district general hospital or equivalent may encounter. Conditions discussed include paediatric respiratory emergencies, sepsis, status epilepticus, the acute abdomen in the newborn, intussusception, the bleeding tonsil, trauma and the child with burns.
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Randomized Controlled Trial
A randomised controlled trial of dexmedetomidine for suspension laryngoscopy.
We randomly allocated 80 patients to intravenous dexmedetomidine (0.25, 0.5, or 1 μg.kg(-1) ) or placebo 15 min before anaesthetic induction. Dexmedetomidine 0.5 and 1.0 μg.kg(-1) significantly reduced the mean (95% CI) propofol effect-site concentrations by 0.83 (0.63-1.03) μg.ml(-1) , p = 0.001 and 1.29 (1.12-1.46) μg.ml(-1) , p = 0.0003 at intubation, by 1.05 (0.85-1.25 μg.ml(-1) , p = 0.0006 and 1.33 (1.15-1.51) μg.ml(-1) , p = 0.0002 when surgery started, and by 0.59 (0.39-0.79) μg.ml(-1) , p = 0.030 and 0.72 (0.57-0.87) μg.ml(-1) , p = 0.004 on completion of surgery, respectively. ⋯ Bradycardia was treated after dexmedetomidine in six patients: five after 1.0 μg.kg(-1) ; and one after 0.25 μg.kg(-1). Single-dose dexmedetomidine can reduce anaesthetic requirements, with both desirable and undesirable haemodynamic effects.
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Over the past 12 years, the United Kingdom Defence Medical Services have evolved an integrated 'damage control resuscitation - damage control surgery' sequence for the management of patients sustaining complex injuries. During 2009, over 3200 units of blood products were administered as massive transfusions to severely injured UK personnel. ⋯ A key goal is to provide resuscitation seamlessly throughout surgery, so that patients leave the operating room with their normal physiology restored. This article outlines the current management of haemorrhage and coagulation employed in Afghanistan from the point of wounding to transfer back to the National Health Service.
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In this, the second of two articles covering specific medical emergencies, we discuss the definitions, epidemiology, pathophysiology, acute and chronic management of pulmonary embolus and acute severe asthma.