Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Jun 2018
The pupillary light reflex for predicting the risk of hypotension after spinal anaesthesia for elective caesarean section.
The balance between the sympathetic and parasympathetic systems could be used to predict the onset of hypotension following spinal anaesthesia. The autonomic innervation of the pupil may reflect this balance. The aim of this study was to evaluate the ability of pupillometry to predict the risk of hypotension after spinal anaesthesia for caesarean section. ⋯ Following spinal anaesthesia in patients undergoing caesarean section, though the predictive capacity pupillary reaction latency for the onset of hypotension and severe hypotension is poor, it is nevertheless the strongest predictor of hypotension identified in our study.
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Anaesth Crit Care Pain Med · Jun 2018
Bundle of care for blunt chest trauma patients improves analgesia but increases rates of intensive care unit admission: A retrospective case-control study.
This single-centre retrospective case-control study aimed to assess the effectiveness of a multidisciplinary clinical pathway for blunt chest trauma patients admitted in emergency department (ED). ⋯ Implementation of a multidisciplinary clinical pathway significantly improves pain control after ED management, but increases the rate of primary ICU admission without significant reduction of secondary respiratory complications.
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Anaesth Crit Care Pain Med · Jun 2018
ReviewRecent directions in personalised acute respiratory distress syndrome medicine.
Acute respiratory distress syndrome (ARDS) is heterogeneous by definition and patient response varies depending on underlying biology and their severity of illness. Although ARDS subtypes have been identified with different prognoses in past studies, the concept of phenotypes or endotypes does not extend to the clinical definition of ARDS. This has possibly hampered the development of therapeutic interventions that target select biological mechanisms of ARDS. ⋯ Several promising approaches to ARDS subtypes capable of predicting therapeutic response, and not just prognosis, are highlighted in this perspective paper. An overview is also provided of current and future directions regarding the provision of personalised ARDS medicine. The importance of delivering the right care, at the right time, to the right patient, is emphasised.
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Anaesth Crit Care Pain Med · Jun 2018
Postoperative fasting after general anaesthesia: A survey of French anaesthesiology practices.
Preoperative fasting is well codified worldwide. In contrast, the literature on the postoperative fasting (POF) is scarce, leading to potentially wide discrepancies among anaesthesiology practices. This survey assessed French POF practices. ⋯ All in all, POF lasted less than 4hours after surgery regardless of airway management. They were shorter with regard to fluid intake, paediatric patients and LMA in comparison with solid food, adult patients and EI respectively.
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Anaesth Crit Care Pain Med · Jun 2018
Spinal anaesthesia in outpatient and conventional surgery: A point of view from experienced French anaesthetists.
The objective of this investigation was to evaluate the practice of spinal anaesthesia among French anaesthetists in inpatient and outpatient settings. ⋯ New local anaesthetics are beginning to be used for outpatient spinal anaesthesia due to their interesting pharmacodynamic profile in this context. This study will provide a basis for evaluating future changes in practice.