British journal of anaesthesia
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Day case surgery is becoming more acceptable, even for patients with complex medical conditions. Current recommendations suggest that patients who are graded as American Society of Anaesthesiologists physical status (ASA) III may be suitable for this approach. There is only a small amount of published data available to support this. We present a retrospective review of ASA III patients who had undergone day surgical procedures in our unit. ⋯ With good pre-assessment and adequate preparation ASA III patients can be treated safely in the day surgery setting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Preoperative saline versus gelatin for hip fracture patients; a randomized trial of 396 patients.
The aim of this study was to determine if the preoperative administration of 500 ml of a gelatin colloid solution intravenously before hip fracture surgery improves outcome, compared with a conventional i.v. fluid regime with a crystalloid solution. ⋯ The inclusion of 500 ml of colloid solution to the i.v. fluid regime before hip fracture surgery does not improve outcome.
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Sympathomimetic drugs are assumed to have no direct effects on cerebral haemodynamics on the basis of animal experiments; there is little evidence of their direct effects in humans. This study aimed to address this issue. ⋯ Sympathomimetic agents do not significantly change cerebrovascular homeostasis as assessed by the transient hyperaemic response test, reactivity to carbon dioxide and estimated cerebral perfusion pressure.
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There are regional differences in the effects of anaesthetics agents and perioperative stimuli on the EEG. We studied the topography of the EEG during induction of anaesthesia and intubation in patients receiving thiopental and fentanyl to document regional electrical brain activity. ⋯ Changes in alpha and delta power were identified as the most sensitive EEG measures of regional changes in electrical brain activity during anaesthesia and noxious stimulation.
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During EEG suppression with isoflurane or sevoflurane anaesthesia, median nerve stimulation causes cortical responses of two kinds: an N20 wave with a latency of 20 ms and an EEG burst with a latency of 200 ms. We tested the possibility that median nerve stimulation during EEG suppression with propofol would cause an EEG response that was consistent enough to be of use for neuromonitoring. ⋯ In addition to SSEP (somatosensory evoked potentials), three different evoked responses are noted that could be useful for clinical monitoring.