British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Early recovery after remifentanil-pronounced compared with propofol-pronounced total intravenous anaesthesia for short painful procedures.
We compared recovery from high-dose propofol/low-dose remifentanil ('propofol-pronounced') compared with high-dose remifentanil/low-dose propofol ('remifentanil-pronounced') anaesthesia. ⋯ In patients having short painful surgery, less propofol does not give faster recovery as long as the same anaesthetic level (as indicated by BIS and clinical signs) is maintained by more remifentanil. However, recovery times were less variable following remifentanil-pronounced anaesthesia suggesting a more predictable recovery.
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Randomized Controlled Trial Clinical Trial
Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting.
This study compares the cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting (PONV). ⋯ Ondansetron+droperidol is cheaper and at least as effective as ondansetron+ dexamethasone, and it is more effective than dexamethasone+droperidol with a reasonable extra cost.
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Randomized Controlled Trial Clinical Trial
Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters.
ECG guidance is widely used for positioning central venous catheters (CVCs) in the superior vena cava. We noticed a higher incidence of a more perpendicular angle between the catheter tip and the vessel wall after left-sided ECG-guided catheter positioning. To investigate the value of left-sided ECG guidance, we performed this prospective study. ⋯ Intra-atrial ECG does not detect the junction between the superior vena cava and right atrium. It is not a reliable method for confirming position of left-sided CVCs. Post-procedural CXRs are recommended for left-sided, but not right-sided CVCs.
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We assessed appropriate intraoperative use of whole blood during elective surgery. ⋯ Current intraoperative blood use is sub-optimal. Intraoperative haemoglobin estimation is an effective and simple measurement to improve appropriate use of blood. The indication for transfusion should be recorded in the case notes.