British journal of anaesthesia
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Randomized Controlled Trial
Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy.
Magnesium is well known to inhibit catecholamine release and attenuate vasopressin-stimulated vasoconstriction. We investigated whether i.v. magnesium sulphate attenuates the haemodynamic stress responses to pneumoperitoneum by changing neurohumoral responses during laparoscopic cholecystectomy. ⋯ I.V. magnesium sulphate before pneumoperitoneum attenuates arterial pressure increases during laparoscopic cholecystectomy. This attenuation is apparently related to reductions in the release of catecholamine, vasopressin, or both.
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Randomized Controlled Trial Multicenter Study
Efficacy of high-fidelity simulation debriefing on the performance of practicing anaesthetists in simulated scenarios.
Research into adverse events in hospitalized patients suggests that a significant number are preventable. The purpose of this randomized, controlled study was to determine if simulation-based debriefing improved performance of practicing anaesthetists managing high-fidelity simulation scenarios. ⋯ We found a modest improvement in performance on a DSC in the debriefed group and overall improvement in both control and debriefed groups using a GRS. Whether this improvement translates into clinical practice has yet to be determined.
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Randomized Controlled Trial Multicenter Study
Cognitive aid for neonatal resuscitation: a prospective single-blinded randomized controlled trial.
Retention of skills and knowledge after neonatal resuscitation courses (NRP) is known to be problematic. The use of cognitive aids is mandatory in industries such as aviation, to avoid dependence on memory when decision-making in critical situations. We aimed to prospectively investigate the effect of a cognitive aid on the performance of simulated neonatal resuscitation. ⋯ Retention of skills after NRP training is poor. The infrequent use of the cognitive aid may be the reason that it did not improve performance. Further research is required to investigate whether cognitive aids can be useful if their use is incorporated into the NRP training.
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A key aspect of the practice of anaesthesia is the ability to perform practical procedures efficiently and safely. Decreased working hours during training, an increasing focus on patient safety, and greater accountability have resulted in a paradigm shift in medical education. The resulting international trend towards competency-based training demands robust methods of evaluation of all domains of learning. ⋯ The current best evidence for a gold standard for assessment of procedural skills in anaesthesia consists of a combination of previously validated checklists and global rating scales, used prospectively by a trained observer, for a procedure performed in an actual patient. Future research should include core assessment parameters to ensure methodological rigor and facilitate robust comparisons with other studies: (i) reliability, (ii) validity, (iii) feasibility, (iv) cost-effectiveness, and (v) comprehensiveness with varying levels of difficulty. Simulation may become a key part of the future of formative and summative skills assessment in anaesthesia; however, research is required to develop and test simulators that are realistic enough to be suitable for use in high-stakes evaluation.
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Randomized Controlled Trial
Cardiovascular reflex responses to temporal reduction in arterial pressure during dexmedetomidine infusion: a double-blind, randomized, and placebo-controlled study.
The low and moderate doses of dexmedetomidine reduce arterial pressure and heart rate (HR), suggesting attenuation of sympathetic activity and dominance of cardiac-vagal activity. These autonomic responses under dexmedetomidine sedation may attenuate cardiovascular reflex responses to temporal reduction in arterial pressure, inducing a severe hypotension. We therefore investigated the effects of dexmedetomidine on cardiovascular reflex responses to temporal reduction in arterial pressure induced by the thigh cuff method. ⋯ The present results indicated that dexmedetomidine weakens arterial pressure preservation and HR responses after thigh cuff deflation, suggesting attenuated cardiovascular reflexes. Therefore, it must be cautioned that dexmedetomidine can lead to further and sustained reduction in arterial pressure during transient hypotension induced by postural changes, haemorrhage, and/or other stresses.