Articles: anesthetics.
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Anesthesia and analgesia · Jan 2025
Multicenter StudyIdentifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis.
Intraoperative events and clinical management of deceased organ donors after brain death are poorly characterized and may consequently vary between hospitals and organ procurement organization (OPO) regions. In a multicenter cohort, we sought to estimate the incidence of hypotension and anesthetic and nonanesthetic medication use during organ recovery procedures. ⋯ Despite guidelines recommending maintenance of MAP >60 mm Hg in adult brain-dead organ donors, hypotension during recovery procedures was common. Future research is needed to clarify the relationship between intraoperative events with donation and transplantation outcomes and to identify best practices for the anesthetic management of brain-dead donors in the operating room.
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Anesthesia and analgesia · Jan 2025
A Cognitive Load Theory Perspective of the Undergraduate Anesthesia Curricula in South Africa.
Safe anesthesia is indispensable to achieve global safe surgery and equitable health care access. The disease burden and lack of specialists in South Africa (SA) require junior, nonspecialist doctors to be fit-for-purpose from day 1 when they provide anesthetic services in peripheral hospitals with limited supervision. Graduating students report low self-perceived preparedness for administering anesthesia, but it is not known how their curricular experiences influence their learning. Cognitive load theory defines intrinsic, extraneous, and germane cognitive loads (subtypes). Intrinsic load relates to learning tasks, extraneous load to distractions, and germane load to students' learning processes. This study used a cognitive load theory lens to explore SA students' experiences of their undergraduate anesthesia training. ⋯ Cognitive load theory provided a useful theoretical basis for understanding students' curricular experiences. The COLOAD framework suggests a microlevel interrelatedness of the constituting elements of the 3 cognitive load subtypes. This has implications for curriculum design, pedagogy, and student support. Learning outcomes development and curriculum mapping are important to ensure a lean curriculum, but measures to enhance germane cognitive load might be equally important to achieve competence. Attention to the hidden curriculum and active promotion of reflective practice might reduce cognitive load in complex learning environments such as anesthesia training.
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Paediatric anaesthesia · Jan 2025
Review Meta AnalysisPerioperative intravenous lignocaine for pediatric postoperative pain-A systematic review and meta-analysis.
Intravenous lignocaine has been used as an analgesic adjunct in pediatric surgical patients, although its efficacy is still unclear. ⋯ There is low quality evidence to suggest that perioperative intravenous lignocaine bolus followed by an infusion significantly reduced the opioid consumption on the first postoperative day in pediatric surgical patients. The effects of perioperative lignocaine on postoperative pain scores and the need for rescue analgesia are uncertain.
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Randomized Controlled Trial
Ultrasound-guided Double-point Versus Single-point Serratus Anterior Plane Block for Modified Radical Mastectomy: A Randomized Controlled Trial.
The double-point serratus anterior plane block (SAPB) covers more area, including the axilla, than the single-point approach, potentially offering better pain relief after modified radical mastectomy (MRM). The objective of this study were to evaluate the clinical outcomes of these 2 procedures for patients treated with MRMs. ⋯ Double-point SAPB offers wider anesthetic spread but shows no significant clinical advantage in pain or axillary comfort over single-point SAPB after MRM.
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Randomized Controlled Trial Comparative Study
Combined spinal-epidural vs. dural puncture epidural techniques for labour analgesia: a randomised controlled trial.
The dural puncture epidural technique is a modification of the combined spinal-epidural technique. Data comparing the two techniques are limited. We performed this randomised study to compare the quality of labour analgesia following initiation of analgesia with the dural puncture epidural vs. the combined spinal-epidural technique. ⋯ There were no significant differences in the quality of labour analgesia following initiation of a combined spinal-epidural compared with a dural puncture epidural technique.