British journal of anaesthesia
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Anaesthesia-related neurotoxicity in the developing brain has been observed in animal models and suggested by observational human trials. Conclusive, quality evidence directing significant practice change is however lacking. Anaesthetists should be aware of the current evidence and future directions of research into this important area.
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Randomized Controlled Trial
Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women.
Aortocaval compression (ACC) can result in haemodynamic disturbances and uteroplacental hypoperfusion in parturients. Its detection is difficult because in most patients, sympathetic compensation results in no signs or symptoms. However, profound hypotension may develop after sympathectomy during regional anaesthesia. In this prospective observational study, we aimed to detect ACC by analysing haemodynamic changes in term parturients who were positioned sequentially at different angles of lateral tilt. ⋯ Patients with ACC can be identified by the CO changes from serial measurements between supine, 15°, or full lateral tilt. Our findings suggest that in non-labouring parturients, ACC is asymptomatic and can be effectively minimized by the use of a left lateral tilt of 15° or greater.
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Meta Analysis
Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome.
Obstructive sleep apnoea (OSA) is often undiagnosed before elective surgery and may predispose patients to perioperative complications. ⋯ The incidence of postoperative desaturation, respiratory failure, postoperative cardiac events, and ICU transfers was higher in patients with OSA.
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The publication of To Err Is Human in the USA and An Organisation with a Memory in the UK more than a decade ago put patient safety firmly on the clinical and policy agenda. To date, however, progress in improving safety and outcomes of hospitalized patients has been slower than the authors of these reports had envisaged. ⋯ We then focus on what we believe is a critical part of the healthcare system that can contribute to safety but also to error-healthcare teams. Finally, we review team training interventions and tools available for the assessment and improvement of team performance and we offer recommendations based on the existing evidence-base that have potential to improve patient safety and outcomes in the coming decade.
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Recommendations for resuscitation of patients in early haemorrhagic shock, with active ongoing bleeding, have evolved in recent years. This review covers current theories of the pathophysiology of shock and recommended treatments, including damage control surgery, deliberate hypotensive management, administration of antifibrinolytics, early support of the coagulation system, and the possible role of deep anaesthesia. Future directions for resuscitation research are discussed.