British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study
Addition of droperidol to prophylactic ondansetron and dexamethasone in children at high risk for postoperative vomiting. A randomized, controlled, double-blind study.
: The combination of dexamethasone (DEX), ondansetron (OND) and droperidol (DRO) is efficacious in preventing postoperative nausea and vomiting in adults, but has not been well assessed in children. ⋯ NCT01739985.
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Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. ⋯ Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit. Whether this leads to fewer intraoperative complications, an improved quality of recovery, or both after laparoscopic surgery should be pursued in future studies. The review methodology was specified in advance and registered at Prospero on July 27, 2016, registration number CRD42016042144.
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Perioperative anaemia is common. Physicians believe that patients at increased cardiac risk do not tolerate anaemia and, consequently, these patients receive transfusions earlier and more often. This practice runs counter to a growing body of evidence that perioperative red blood cell (RBC) transfusion is harmful The aims of this study were as follows: (i) to assess the effects of transfusion at moderate to severely low ranges of postoperative haemoglobin concentrations; and (ii) to assess whether transfusion was beneficial in patients at high cardiac risk within these haemoglobin ranges. ⋯ High cardiac risk was associated with increased incidence of anaemia, transfusion, and mortality. Red blood cell transfusion is associated with reduced mortality only in high cardiac risk patients with nadir postoperative haemoglobin concentration <80 g litre -1 . Transfusion, the main treatment for postoperative anaemia, does not appear to be associated with reduced postoperative mortality at higher nadir haemoglobin ranges.
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Randomized Controlled Trial
Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers.
Daily and globally, millions of adult hospitalized patients are exposed to maintenance i.v. fluid solutions supported by limited scientific evidence. In particular, it remains unclear whether fluid tonicity contributes to the recently established detrimental effects of fluid, sodium, and chloride overload. ⋯ ClinicalTrials.gov (NCT02822898) and EudraCT (2016-001846-24).
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An innovative approach to choosing hospital equipment is to consider the environmental costs in addition to other costs and benefits. ⋯ For an Australian hospital with six operating rooms, converting from single-use to reusable anaesthetic equipment saved more than AUD$30 000 (£18 000) per annum, but increased the CO 2 emissions by almost 10%. The CO 2 offset is highly dependent on the power source mix, while water consumption is greater for reusable equipment.