British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of ramosetron with ondansetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery.
Ramosetron is a new selective 5-hydroxytryptamine type 3 (5-HT(3)) receptor antagonist that reportedly has more potent antiemetic effects compared with other 5-HT(3) receptor antagonists. The purpose of this study was to evaluate the efficacy of ramosetron for the prevention of postoperative nausea and vomiting (PONV) with that of ondansetron or placebo in high-risk patients undergoing gynaecological surgery. ⋯ Ramosetron 0.3 mg i.v. was as effective as ondansetron 8 mg i.v. in decreasing the incidence of PONV and reducing nausea severity in female patients during the first 24 h after gynaecological surgery.
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Randomized Controlled Trial
Influence of different remifentanil concentrations on the performance of the surgical stress index to detect a standardized painful stimulus during sevoflurane anaesthesia.
Although measurement of cerebral hypnotic drug effect and muscle relaxation is common clinical routine during anaesthesia, a reliable measurement of the neurophysiological effects evoked by a painful stimulus is still missing. Recently, the surgical stress index (SSI) has been introduced as a surrogate measure of 'nociception'. The present study aimed to examine the influence of increasing remifentanil concentrations on the ability of SSI to detect a standardized painful stimulus during sevoflurane anaesthesia. ⋯ The SSI response to tetanic stimulation was dependent on the remifentanil concentration.
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The mini-Clinical Evaluation Exercise (mini-CEX) is a workplace-based assessment which may be useful in anaesthesia training. However, its value depends on how supervisors use it with their trainees. This study analyses experience with the mini-CEX after its introduction into anaesthesia departments in our institution. ⋯ Mini-CEX formalized the supervisory relationship, promoting educational interactions. During the observation period, trainees took responsibility for decisions, and specialists learnt more about their abilities. The structured format broadened the scope of feedback and made it easier to address performance gaps. We identified factors that facilitated or hindered implementation, or limited effective feedback and the ability to address poor performance. From this analysis, we propose strategies for the implementation of mini-CEX, and recommendations for assessor training to improve the quality and value of the assessments.
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The implementation of the European Working Time Directive (WTD) has reduced the hours worked by trainees in the UK to a maximum of 56 h per week. With a further and final reduction to 48 h per week scheduled for August 2009, there is concern amongst doctors about the impact on training and on patient care. Paediatric anaesthesia is one of the specialist areas of anaesthesia for which the Royal College of Anaesthetists (RCoA) recommends a minimum caseload during the period of advanced training. ⋯ Since the implementation of the WTD, there has been a significant reduction in the number of cases performed by SpRs in paediatric anaesthesia and they are no longer achieving the RCoA recommended minimum numbers for advanced training.
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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.