Journal of perioperative practice
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Cardiac surgery is one of the largest users of blood and blood products--currently estimated at 15% of U. K. blood stocks. While the blood supply could be considered to be the safest it has ever been, there are well recognised risks associated with the transfusion of red cells and blood products. It is appropriate that attempts should be made to decrease and optimise the transfusion of blood and blood products.
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Spinal anaesthesia is an effective method of delivering anaesthesia for primary total knee replacement. A regional technique has several benefits over an opioid based general anaesthetic (Fischer 2009) (Figure 1). Pre-medication and sedation is commonly used as an adjunct to create anxiolysis and reduce stress which could be provoked by being awake in the theatre environment. However, sedation is not without its disadvantages (Absalom & Adapa 2007) (Figure 2).
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A retrospective audit of diabetes glycaemic control optimisation in one primary care practice prior to elective surgery was undertaken. Collected data included: demographics, glycosylated haemoglobin A1c (HbA1c) records, evidence of diabetes related glycaemic control optimisation. Of the 82 patients in this study only 46 had an HbA1c measured pre-operatively and only 8 had a review with the practice nurse to optimise glycaemic control. Actions arising from quality improvement programmes are needed to optimise glycaemic control in diabetic patients undergoing elective surgery.