British journal of anaesthesia
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Severe sepsis and septic shock is common and frequently fatal. Over the last few years, the primary treatments demonstrated to improve outcome from several major clinical trials have finally emerged. ⋯ Given their pleiotropic effects related to many pathophysiological determinants of sepsis, statin therapy could be the next step in the search for adjuvant therapy. A future challenge may be to test both the efficacy and the safety by large randomized controlled clinical trials ascertaining the effects of statins administered at the onset of sepsis and in patients with severe sepsis or septic shock admitted into intensive care units.
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Randomized Controlled Trial
Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia.
This randomized, double-blind, prospective study was undertaken to evaluate the effects of magnesium sulphate on anaesthetic requirements and postoperative analgesia in patients undergoing total i.v. anaesthesia (TIVA). ⋯ I.v. magnesium sulphate during TIVA reduced rocuronium requirement and improved the quality of postoperative analgesia.
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Multicenter Study
Perioperative tobacco use interventions in Japan: a survey of thoracic surgeons and anaesthesiologists.
Tobacco use interventions in surgical patients who smoke could benefit both their short-term outcome and long-term health. Anaesthesiologists and surgeons can play key roles in delivering these interventions. This study determined the practices, attitudes, and beliefs of these physicians regarding tobacco use interventions in Japan. ⋯ Although current rates of intervention provided by anaesthesiologists and surgeons are low, there is considerable interest among these physicians in learning more about interventions. Given the relatively high prevalence of smoking in Japan and the potential for surgery to serve as a 'teachable moment' to promote abstinence from smoking, leadership by these specialists in the area of tobacco control could have a major impact on public health in Japan.
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Comparative Study
Effect of chest compressions on the time taken to insert airway devices in a manikin.
Resuscitation guidelines recommend that chest compressions should continue throughout attempts to place airway devices. Few data support the use of the tracheal tube over supraglottic airway devices (SADs) during cardiopulmonary arrest. This study was designed to evaluate the speed with which different airway devices could be placed with and without interrupting chest compressions. ⋯ Our results show that continuing chest compressions has a minor effect on time for tracheal intubation and until clear human data are available the recommendation to intubate without interrupting CPR is therefore justified. The PLMA and igel (SADs with a gastric drain tube) were both faster to insert than the cLMA and offer additional benefits. They should be considered for use in CPR.
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Case Reports
Case series: Protection from aspiration and failure of protection from aspiration with the i-gel airway.
We present three patients of regurgitation while using the i-gel supraglottic airway in 280 patients. In two patients, the i-gel completely protected the airway from aspiration. ⋯ The i-gel has features designed to separate the airway and gastro-intestinal tracts and as such should offer some protection against aspiration. However, the efficacy of these features has not been confirmed, and further study is required to determine the safety profile of the device.