British journal of anaesthesia
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Nineteen previously trained resident anaesthetists were instructed to perform adult single-rescuer basic life support for 5 min on a manikin, in a double-blind crossover design, changing the hand of contact with the sternum from right to left while performing external cardiac compression (ECC). Total, correct and incorrect ECCs comprising of inadequate depth, wrong hand placement, incomplete relaxation and too much compression were recorded and grouped according to the dominant hand (group DH) or non-dominant hand (group NH) in contact with the sternum. The number of correct ECCs was significantly greater in group DH, median 141 compared to group NH, median 97; P < 0.005. ⋯ Similarly, the incidence of wrong hand placement was significantly higher in group NH; median of 4 versus median of 0 in group DH, P < 0.05. The incidence of incomplete relaxation and too much ECC was not significantly different between the two groups (P < 0.05). We conclude that ECC is performed with fewer errors when the dominant hand of the rescuer is placed in contact with the sternum.
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Pharmacokinetic parameters of inhaled anaesthetics have previously been assessed experimentally in healthy volunteers. In contrast, we developed a method to estimate pharmacokinetic parameters under clinical conditions. We obtained data from the continuous routine monitoring of fractional concentration and ventilation during anaesthesia with desflurane, isoflurane and sevoflurane. ⋯ The most stable parameter was the intercompartmental clearance, and the most sensitive parameter was the volume of distribution. The bias in pharmacokinetic parameters caused by adding errors to measured concentrations was similar for the different compounds. We conclude that the model allows the estimation of an alternative set of pharmacokinetic parameters that can reliably describe the behaviour of volatile anaesthetics under clinical conditions, and allow comparison between agents.
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Meta Analysis
General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials.
Hip fracture surgery is common and the population at risk is generally elderly. There is no consensus of opinion regarding the safest form of anaesthesia for these patients. We performed a meta-analysis of 15 randomized trials that compare morbidity and mortality associated with general or regional anaesthesia for hip fracture patients. ⋯ No other outcome measures reached a statistically significant difference. There was a tendency towards a lower incidence of myocardial infarction, confusion and postoperative hypoxia in the regional anaesthetic group, and cerebrovascular accident and intra-operative hypotension in the general anaesthetic group. We conclude that there are marginal advantages for regional anaesthesia compared to general anaesthesia for hip fracture patients in terms of early mortality and risk of deep vein thrombosis.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery.
The aim of this study was to evaluate the prophylactic antiemetic effect of i.v. dexamethasone in women undergoing ambulatory laparoscopic tubal ligation. Ninety patients requiring general anaesthesia for laparoscopic tubal ligation were enrolled in a randomized, double-blind, placebo-controlled study. Forty-five patients received dexamethasone 10 mg i.v. and 45 received saline 2 ml i.v. at the induction of anaesthesia. ⋯ Seven per cent of patients in the dexamethasone group, compared with 28% of patients in the saline group, received a rescue antiemetic (P < 0.05). During the 24-h postoperative observation period, 34% of patients in the dexamethasone group, compared with 73% of patients in the saline group, reported nausea and vomiting (P < 0.001). We conclude that dexamethasone 10 mg significantly decreases the incidence of postoperative nausea and vomiting in women undergoing ambulatory laparoscopic tubal ligation.