Anaesthesia
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Review Meta Analysis
A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks.
Perineural dexamethasone may significantly increase the duration of analgesia after regional blockade, though without dose-response effect.
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In 153 AD, the Roman physician Scribonius Largus identified that electric current had analgesic properties, instructing patients to stand on an electric ray for the treatment of gout. In 2014, transcranial magnetic stimulation was approved by the National Institute for Health and Care Excellence for the treatment of migraine. ⋯ Significant advances have been made over the last century in particular, and during the 1960s and 1970s, tens of thousands of patients were reportedly anaesthetised for surgical interventions using electric current as the anaesthetic agent. Many medical interventions, including transcutaneous electrical nerve stimulation and deep brain stimulation, have evolved in the aftermath of investigations into electroanaesthesia; the potential for electric current to be an anaesthetic agent of the future still exists.
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Pulmonary hypertension is a complex disorder of the pulmonary vasculature that leads to increased peri-operative morbidity and mortality. Non-cardiac surgery constitutes a significant risk in patients with pulmonary hypertension. ⋯ A thorough understanding of the pathophysiology, the severity of the disease and its treatment modalities is required to deliver optimal peri-operative care. This review provides an evidence-based overview of the definition, classification, pathophysiology, diagnosis and treatment of pulmonary hypertension and focuses on the peri-operative management and treatment of pulmonary hypertensive crises in a non-cardiac setting.
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The aetiology and management of haemostatic abnormalities in critical care patients are considered in this narrative review. The mechanisms of normal haemostasis and derangements that occur as a result of sepsis and organ dysfunction are discussed. Finally, the management of haemostatic abnormalities as they relate to critical care practice are considered, including the management of heparin-induced thrombocytopenia.
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We describe the development and laboratory assessment of a refined prototype tactile feedback device for the safe and accurate application of cricoid pressure. We recruited 20 operating department practitioners and compared their performance of cricoid pressure on a training simulator using both the device and a manual unaided technique. ⋯ Most importantly, the percentage of force applications that deviated from target by more than 10 N decreased from 18% to 7% (p < 0.01). The device requires no prior training, is cheap to manufacture, is single-use and requires no power to operate, whilst ensuring that the correct force is always consistently applied.