British journal of anaesthesia
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Pulse pressure variation (PPV) and stroke volume variation (SVV) are robust indicators of fluid responsiveness in mechanically ventilated supine patients. The aim of the study was to evaluate the ability of PPV and SVV to predict fluid responsiveness in mechanically ventilated patients in the prone position (PP) during scoliosis surgery. ⋯ PP induces a significant increase in PPV and SVV but does not alter their abilities to predict fluid responsiveness.
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Performance assessment is becoming increasingly necessary in the medical workplace. Hospitals and patients expect safety, and under-performance by a doctor can compromise standards. By describing and quantifying performance, positive behaviour can be encouraged and unsafe behaviour remedied. Anaesthesia Non-Technical Skills (ANTS) is a behavioural marker system that can be used to assess non-technical skills in the workplace. ⋯ Anaesthetists could not be trained to reliably use ANTS as a summative assessment tool using our 1 day programme. There was an inadequate correlation of scores between participants and experts. Two major problems contributed to the lack of agreement. Observed behaviours were often misclassified into the incorrect element and safety beliefs varied among anaesthetists. Other reasons for the failure to achieve success and potential future direction are discussed.
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The administration of anti-platelet agents to surgical patients with a history of coronary artery disease or peripheral vascular disease represents an everyday challenge to anaesthesiologists when epidural anaesthesia or analgesia is to be considered. Practice guidelines suggest stopping clopidogrel at least 7 days before placing an epidural catheter. Withholding anti-platelet drugs represents a great risk to many of these patients. ⋯ No neurological complications were found as a result of placing an epidural catheter in patients actively taking clopidogrel. Owing to the small sample size, we cannot recommend the liberal use of epidural analgesia with ongoing clopidogrel administration at this time. Further prospective studies, with larger sample size, are needed in order to substantiate our findings.
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The steep (40 degrees ) Trendelenburg position optimizes surgical exposure during robotic prostatectomy. The goal of the current study was to investigate the combined effect of this position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during these procedures. ⋯ The combination of the prolonged steep Trendelenburg position and CO(2) pneumoperitoneum was well tolerated. Haemodynamic and pulmonary variables remained within safe limits. Regional cerebral oxygenation was well preserved and CPP remained within the limits between which cerebral blood flow is usually considered to be maintained by cerebral autoregulation.