Anaesthesia
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Review Meta Analysis Comparative Study
Intra-operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta-analysis with trial sequential analysis.
Intraoperative dexmedetomidine infusions result in less postoperative pain, hypotension, shivering and PONV than remifentanil.
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Randomized Controlled Trial Multicenter Study Retracted Publication
A multicentre randomised controlled trial of the effect of intra-operative dexmedetomidine on cognitive decline after surgery.
Dexmedetomidine may reduce post-operative delirium and at one month post-operative cognitive decline in elderly patients, associated with changes in brain-derived neurotrophic factor.
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Letter Practice Guideline
Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery.
Guidelines are presented for the organisational and clinical management of anaesthesia for day-case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion.
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Comparative Study
Cardiac output monitoring with thermodilution pulse-contour analysis vs. non-invasive pulse-contour analysis.
Intravenous fluid boluses guided by changes in stroke volume improve some outcomes after major surgery, but invasive measurments may limit use. From October 2016 to May 2018, we compared the agreement and trending ability of a photoplethysmographic device (Clearsight) with a PiCCO, calibrated by thermodilution, for haemodynamic variables in 20 adults undergoing major elective surgery. We analysed 4519 measurement pairs, including before and after 68 boluses of 250 ml crystalloid. ⋯ The coefficient of agreement for stroke volume variation after fluid boluses between the two devices was 0.79 ('strong'). Fluid boluses that increased stroke volume by ≥ 10% increased mean absolute volume (SD) and mean percentage (SD) stroke volume measurements similarly for the invasive pulse-contour cardiac output and Clearsight devices: 9 (4) ml vs. 8 (4) ml and 16% (8%) vs. 15% (10%), respectively, p > 0.05. The non-invasive Clearsight pulse-contour analysis was similar to an invasive pulse-contour device in measuring absolute and changing stroke volumes during major surgery.