British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Xenon or propofol anaesthesia for patients at cardiovascular risk in non-cardiac surgery.
The results of two European multi-centre trials on xenon anaesthesia led to the hypothesis that a xenon-based anaesthetic would keep left ventricular (LV) and circulatory function more stable than a propofol-based anaesthetic, in patients with coronary artery disease (CAD). ⋯ Xenon anaesthesia provided a higher arterial pressure level than propofol, with no signs of cardiovascular compromise, in patients with CAD. Echocardiographic indices showed better LV function with xenon.
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Information has been very limited on the pharmacokinetics of the selective alpha(2)-adrenoceptor agonist dexmedetomidine in children, particularly in children <2 yr of age. ⋯ To reach a certain plasma concentration, children younger than 2 yr of age evidently need larger initial doses of dexmedetomidine than the older children, as young children have a larger volume of distribution of the drug than older children and adults. Since the total plasma clearance of dexmedetomidine is independent of age, similar rates of infusion can be used in younger and older children to maintain a steady-state concentration of dexmedetomidine in plasma.
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A multidisciplinary panel of physicians was convened by Network for Advancement of Transfusion Alternatives to review the evidence on the efficacy and safety of i.v. iron administration to increase haemoglobin levels and reduce blood transfusion in patients undergoing surgery, and to develop a consensus statement on perioperative use of i.v. iron as a transfusion alternative. After conducting a systematic literature search to identify the relevant studies, critical evaluation of the evidence was performed and recommendations formulated using the Grades of Recommendation Assessment, Development and Evaluation Working Group methodology. Two randomized controlled trials (RCTs) and six observational studies in orthopaedic and cardiac surgery were evaluated. ⋯ For all other types of surgery, no evidence-based recommendation can be made. The panel recommends that large, prospective, RCTs be undertaken to evaluate the efficacy and safety of i.v. iron administration in surgical patients. The implementation of some general good practice points is suggested.
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Measuring patient satisfaction after anaesthesia care is complex. The existing patient satisfaction questionnaires are limited and omit aspects of patient satisfaction, such as professional competence, information provision, service, and staff-patient relationship. The aim of our study was to develop a valid and reliable self-reported multidimensional questionnaire assessing patient satisfaction that included these issues. ⋯ We developed the LPPSq questionnaire to measure patient satisfaction with perioperative care, of which anaesthesia care is an important element. In this study, information provision and the relationship between staff and patient were the major determinants of patient satisfaction.
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Case Reports
Unusually early onset of post-dural puncture headache after spinal anaesthesia using a 27G Whittacre needle.
We present a case of a post-dural puncture headache occurring 20 min after spinal anaesthesia using a 27-Gauge Whittacre needle. The unusually early occurrence of this complication is thought to be the first of its kind reported in the literature and highlights the novelty of this case.