British journal of anaesthesia
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Randomized Controlled Trial
Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery.
Intraoperative fluid therapy regimens using oesophageal Doppler monitoring (ODM) to optimize stroke volume (SV) (goal-directed fluid therapy, GDT) have been associated with a reduction in length of stay (LOS) and complication rates after major surgery. We hypothesized that intraoperative GDT would reduce the time to surgical readiness for discharge (RfD) of patients having major elective colorectal surgery but that this effect might be less marked in aerobically fit patients. ⋯ Intraoperative SV optimization conferred no additional benefit over standard fluid therapy. In an aerobically fit subgroup of patients, GDT was associated with detrimental effects on the primary outcome.
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Multicenter Study
Multicentre cohort study of red blood cell use for revision hip arthroplasty and factors associated with greater risk of allogeneic blood transfusion.
Revision hip arthroplasty (RHA) is associated with high rates of allogeneic blood transfusion (ABT). We aimed to determine factors associated with ABT in patients undergoing RHA in Scottish hospitals, with particular focus on perioperative cell salvage (PCS). ⋯ PCS is an effective blood conservation strategy for RHA, especially for patients with preoperative anaemia, low body weight, or both.
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Many people care deeply about what happens to their own and their loved ones' bodies after death. It is therefore important to capture individuals' wishes and ensure that they are respected as far as practically possible. At the same time, healthcare professionals need to feel confident that they are morally entitled to do what they need to do to ensure that someone's wishes are fulfilled. ⋯ It attempts to reconcile the way in which people are required to express their wish to donate organs with the need to reassure and support the professionals, who will care for them if they become potential donors. Current donor registration processes leave some professionals feeling that donors have not consented in the usual manner to procedures, which might be necessary before death. It is suggested that this issue could be addressed without imposing information overload on prospective donors, by changing the way in which the wish to donate is understood and expressed.
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Donation after circulatory death (DCD) describes the retrieval of organs for the purposes of transplantation that follows death confirmed using circulatory criteria. The persisting shortfall in the availability of organs for transplantation has prompted many countries to re-introduce DCD schemes not only for kidney retrieval but increasingly for other organs with a lower tolerance for warm ischaemia such as the liver, pancreas, and lungs. DCD contrasts in many important respects to the current standard model for deceased donation, namely donation after brain death. ⋯ Many of the concerns about the practice of both controlled and uncontrolled DCD are being addressed by increasing professional consensus on the ethical and legal justification for many of the interventions necessary to facilitate DCD. In some countries, DCD after the withdrawal of active treatment accounts for a substantial proportion of deceased organ donors overall. Where this occurs, there is an increased acceptance that organ and tissue donation should be considered a routine part of end-of-life care in both intensive care unit and emergency department.
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Comparative Study
Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery.
Thromboelastometry (ROTEM(®)) might be useful to detect intraoperative coagulation disorders early in major paediatric surgery. This observational trial compares this technique to standard coagulation tests. ⋯ PT and aPTT cannot be interchangeably used with ROTEM(®) CT. Based on the results of ROTEM(®), recommended thresholds for PT and aPTT might overestimate the need for coagulation therapy. A good correlation was found between the fibrinogen level and the FibTEM assay. In addition, ROTEM(®) offered faster turnaround times.