British journal of anaesthesia
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Randomized Controlled Trial
Dexamethasone alone vs in combination with transcutaneous electrical acupoint stimulation or tropisetron for prevention of postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery.
Postoperative nausea and vomiting (PONV) is commonly reported after surgery and anaesthesia. We compared the effects of combinations of electrical acupoint stimulation or tropisetron with dexamethasone with the effects of dexamethasone alone, for inhibition of PONV in gynaecological patients undergoing laparoscopic surgery. ⋯ NCT 02096835.
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Randomized Controlled Trial
Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery.
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Cancer treatment is associated with significant morbidity and mortality. Surgery is a mainstay of treatment for many tumours, and anaesthetists care for cancer patients on a daily basis. ⋯ Retrospective studies have hinted that regional anaesthesia can play a protective role in cancer surgery, but many of these studies are small and subject to bias. We eagerly await the results of several large, randomized controlled trials examining the impact of regional anaesthesia and analgesia on cancer recurrence and survival.
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Review
Challenges in postdischarge function and recovery: the case of fast-track hip and knee arthroplasty.
This narrative review updates the recent advances in our understanding of the multifactorial pathogenesis for reduced postdischarge physical and cognitive function after fast-track surgery, using total hip and knee arthroplasty as surgical models. Relevant factors discussed include the surgical stress responses and potential methods for controlling postsurgical inflammation, pain, and cognitive dysfunction. ⋯ The need for the development of effective physiotherapy programmes on a patient-specific basis is discussed, along with the need for optimal assessment of postoperative function to guide rehabilitation. Other relevant factors discussed include the role of orthostatic intolerance, sleep disturbances, and blood management, and specific patient populations at risk for adverse outcomes, including psychiatric disorders, to identify and guide future interventions for optimizing functional postdischarge outcomes after fast-track surgery.
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Observational Study
Postoperative pain assessment in children: a pilot study of the usefulness of the analgesia nociception index†.
The ability to perform objective pain assessment is very important in paediatric patients. The goal of this study was to investigate the relationship between the analgesia nociception index (ANI), which is based on the heart rate variability, and objective measurements of pain intensity in young or cognitively impaired children, after surgical or imaging procedures (control group) under general anaesthesia. ⋯ The ANI may provide an objective measurement of acute postoperative pain, which is correlated with that measured on a FLACC scale in young or cognitively impaired children.