British journal of anaesthesia
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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 Comparative Study
Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate.
This prospective, randomized study was designed to compare remifentanil and magnesium sulphate during middle ear surgery in terms of postoperative pain and other complications. ⋯ Both magnesium sulphate and remifentanil when combined with sevoflurane provided adequate controlled hypotension and proper surgical conditions for middle ear surgery. However, patients administered magnesium sulphate had a more favourable postoperative course with better analgesia and less shivering and PONV.
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Multicenter Study
In-theatre training of anaesthetists in a teaching hospital: has it changed over 10 years?
We wished to ascertain in what way recent changes such as Modernising Medical Careers (MMC) and the implementation of the Working Time Directive (WTD) have affected clinical training and experience for anaesthetists in a teaching centre, in particular the provision of training in specialized fields of anaesthesia provided in the teaching hospital. ⋯ In spite of many pressures on training in the clinical setting, the number of cases and senior supervision in specialist modules for trainee anaesthetists in our teaching hospital has been maintained. Continuous monitoring of in-theatre supervision is one way of confirming that training is not compromised as changes occur in hospital workload.
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Malignant hyperthermia (MH) is associated, in the majority of cases, with mutations in RYR1, the gene encoding the skeletal muscle ryanodine receptor. Our primary aim was to assess whether different RYR1 variants are associated with quantitative differences in MH phenotype. ⋯ The MH phenotype differs significantly with different RYR1 variants. Variants leading to more severe MH phenotype are distributed throughout the gene and tend to lie at relatively conserved sites in the protein. Differences in phenotype severity between RYR1 variants may explain the variability in clinical penetrance of MH during anaesthesia and why some variants have been associated with exercise-induced rhabdomyolysis and heat stroke. They may also inform a mutation screening strategy in cases of idiopathic hyperCKaemia.
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The aim of this study was to describe topographic variations in the arrangement of the four main brachial plexus nerves at the junction of the axilla and the upper part of the arm. ⋯ Topographic variations of the four main nerves at the axilla were found to be numerous, the most frequent arrangement being seen in less than two-thirds of the patients. Four separate nerves were seen on static ultrasound imaging at this sectional level of the axilla in only 78% of the cases.