Anaesthesia
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Ischaemia of the extremity from the use of a tourniquet and the subsequent reperfusion contribute to the release of reactive oxygen species. This release may result in injury to remote organs. We performed a qualitative systematic review exploring the interventions used to prevent tourniquet-related oxidative damage in adults undergoing orthopaedic surgery, and the possible relationship between biochemical oxidative stress markers and postoperative clinical outcomes. ⋯ Nine studies tested anaesthetics (propofol, dexmedetomidine, ketamine, and spinal anaesthesia); four studies tested antioxidants (N-acetyl-cysteine, vitamin C, and mannitol); and four studies tested ischaemic pre-conditioning. Fifteen studies showed a significant reduction in biochemical oxidative stress markers. We conclude that propofol and ischaemic pre-conditioning, in particular, appear to show some benefit at reducing oxidative stress following operations under tourniquet; the correlation between a reduction in oxidative stress and postoperative clinical outcomes should be further investigated in the future.
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Randomized Controlled Trial
Does individual experience affect performance during cardiopulmonary resuscitation with additional external distractors?
Cardiopulmonary resuscitation is perceived as a stressful task. Additional external distractors, such as noise and bystanders, may interfere with crucial tasks and might adversely influence patient outcome. We investigated the effects of external distractors on resuscitation performance of anaesthesia residents and consultants with different levels of experience. ⋯ No interaction was observed between additional distractors and experience level (p = 0.4480). External distractors markedly reduce the quality of cardiopulmonary resuscitation. This suggests that all team members, including senior healthcare providers, require training to improve performance under stressful conditions.
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High-intensity renal replacement therapy protocols in intensive care patients with acute kidney injury have failed to translate to improved patient outcomes when compared with lower-intensity protocols. This retrospective study explored the clinical and economic impacts of switching from a 30-35 ml.kg(-1) .h(-1) (high-volume) to a 20 ml.kg(-1) .h(-1) (low-volume) protocol. ⋯ A 25% reduction in daily replacement fluid usage was observed, equating to a cost saving of over £27 000 per annum. In conclusion, a switch from high- to low-volume continuous haemodiafiltration had minimal effects on clinical outcomes and resulted in marked cost savings.
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Review Meta Analysis Comparative Study
Comparative efficacy and safety of the Ambu(®) AuraOnce(™) laryngeal mask airway during general anaesthesia in adults: a systematic review and meta-analysis.
The Ambu AuraOnce™ laryngeal mask is a non-inferior alternative to the LMA Classic and the LMA Unique.
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Randomized Controlled Trial
Analgesic efficacy of pre-operative stellate ganglion block on postoperative pain relief: a randomised controlled trial.
This small trial found that pre-operative stellate ganglion block before upper-limb orthopaedic surgery significantly reduced both 24 h tramadol consumption and pain at rest for up to 6 hours, although the later was of borderline clinical significance.
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