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21. Improving local anaesthetic systemic toxicity (LAST) awareness in maternity care using tailored educational tools (Full text)

Improving local anaesthetic systemic toxicity (LAST) awareness in maternity care using tailored educational tools Local anaesthetic (LA) agents are widely used in maternity care. Although relatively safe, their use does carry risks, the most serious of which is systemic toxicity (LAST). LAST poses a major threat to maternal and neonatal safety due to the frequency of LA administration in maternity care and the under-recognition of toxicity in such settings, which has been reported globally. Our (...) aim was to prevent LAST occurrence in a District General Hospital (DGH) maternity unit by improving staff awareness through the implementation of a tailored educational programme. We used a standardised 14-point questionnaire to evaluate LAST awareness among staff of all disciplines. Domains of interest were LA maximum safe doses, LAST recognition, immediate management and use of antidote. Following baseline assessment, we implemented an educational programme in three stages. Each featured

2018 BMJ Open Quality PubMed abstract

22. Dreaming and awareness during dexmedetomidine- and propofol-induced unresponsiveness. (Full text)

Dreaming and awareness during dexmedetomidine- and propofol-induced unresponsiveness. Experiences during anaesthetic-induced unresponsiveness have previously been investigated by interviews after recovery. To explore whether experiences occur during drug administration, we interviewed participants during target-controlled infusion (TCI) of dexmedetomidine or propofol and after recovery.Healthy participants received dexmedetomidine (n=23) or propofol (n=24) in stepwise increments until loss (...) generated experiences (awareness) were rare and linked to brief arousals. No within drug differences in the prevalence or content of experiences during infusion vs after recovery were observed, but participants receiving dexmedetomidine reported dreaming and awareness more often. Participants receiving dexmedetomidine recognised the emotional sounds better than participants receiving propofol (42% vs 15%), but none reported references to sounds spontaneously.Anaesthetic-induced unresponsiveness does

2018 British Journal of Anaesthesia PubMed abstract

23. Incidence of Intraoperative Awareness in Indian Patient Population

Incidence of Intraoperative Awareness in Indian Patient Population Incidence of Intraoperative Awareness in Indian Patient Population - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Incidence (...) of Intraoperative Awareness in Indian Patient Population The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03571945 Recruitment Status : Recruiting First Posted : June 28, 2018 Last Update Posted : November 27, 2018 See Sponsor: Sir

2018 Clinical Trials

24. Effects of different methods of general anesthesia on intraoperative awareness in surgical patients: a systematic review and meta-analysis

Effects of different methods of general anesthesia on intraoperative awareness in surgical patients: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne

2019 PROSPERO

25. Frequency and Type of Situational Awareness Errors Contributing to Death and Brain Damage: A Closed Claims Analysis. (Full text)

Frequency and Type of Situational Awareness Errors Contributing to Death and Brain Damage: A Closed Claims Analysis. Situational awareness errors may play an important role in the genesis of patient harm. The authors examined closed anesthesia malpractice claims for death or brain damage to determine the frequency and type of situational awareness errors.Surgical and procedural anesthesia death and brain damage claims in the Anesthesia Closed Claims Project database were analyzed. Situational (...) awareness error was defined as failure to perceive relevant clinical information, failure to comprehend the meaning of available information, or failure to project, anticipate, or plan. Patient and case characteristics, primary damaging events, and anesthesia payments in claims with situational awareness errors were compared to other death and brain damage claims from 2002 to 2013.Anesthesiologist situational awareness errors contributed to death or brain damage in 198 of 266 claims (74%). Respiratory

2017 Anesthesiology PubMed abstract

26. Scoping review: Awareness of neurotoxicity from anesthesia in children in otolaryngology literature. (Abstract)

Scoping review: Awareness of neurotoxicity from anesthesia in children in otolaryngology literature. Review otolaryngology literature for awareness of neurotoxicity from general anesthesia in children. Recently, there has been increasing focus in anesthesia literature on the long-term effects of general anesthesia on neurodevelopment. Multiple animal models have demonstrated evidence of neurotoxicity from both inhalational and intravenous anesthetics. Cohort studies also have revealed modestly (...) to January 2005 through December 2015. Articles were screened and reviewed based on predefined inclusion and exclusion criteria.Initial search generated 3,909 articles. After 72 full text articles were reviewed, only seven articles mentioned neurotoxicity as a risk of general anesthesia in pediatric patients.Despite the high volume of pediatric otolaryngologic procedures performed annually, there remains limited awareness in our literature discussing neurotoxicity as an outcome. Prospective data from

2017 Laryngoscope

27. Nitrous oxide-based vs. nitrous oxide-free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review. (Full text)

Nitrous oxide-based vs. nitrous oxide-free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review. Accidental awareness during general anaesthesia can arise from a failure to deliver sufficient anaesthetic agent, or from a patient's resistance to an expected sufficient dose of such an agent. Awareness is 'explicit' if the patient is subsequently able to recall the event. We conducted a systematic review into the effect of nitrous oxide used (...) as part of a general anaesthetic on the risk of accidental awareness in people over the age of five years undergoing general anaesthesia for surgery. We included 15 randomised controlled trials, 14 of which, representing a total of 3439 participants, were included in our primary analysis of the frequency of accidental awareness events. The awareness incidence rate was rare within these studies, and all were considered underpowered with respect to this outcome. The risk of bias across all studies

2017 Anaesthesia PubMed abstract

28. Monitoring the end-tidal concentration of sevoflurane for preventing awareness during anesthesia (MEETS-PANDA): A prospective clinical trial. (Full text)

Monitoring the end-tidal concentration of sevoflurane for preventing awareness during anesthesia (MEETS-PANDA): A prospective clinical trial. It was hypothesized that monitoring end-tidal sevoflurane (ETS) during endoscopic surgery could reduce the incidence of intraoperative awareness in patients undergoing general anesthesia. Herein, the incidence of intraoperative awareness and other correlative factors was recorded and compared.Two thousand five hundred ASA I-III patients aged 18-80 years (...) who underwent general anesthesia were randomly divided into 2 groups (n = 1250): routine care group (R) and ETS concentration group (E). ETS concentration was monitored in group E and maintained at a sevoflurane minimum alveolar concentration (MAC) of 0.7-1.3; group R was monitored using routine care, and the sevoflurane was maintained. Patients were assessed for intraoperative awareness with a questionnaire on their explicit memory 24-48 h after surgery.A total of 2532 patients were selected

2017 International journal of surgery (London, England) Controlled trial quality: uncertain PubMed abstract

29. Intraoperative Awareness and Recall: A Comparative Study of Dexmedetomidine and Propofol in Cardiac Surgery (Full text)

Intraoperative Awareness and Recall: A Comparative Study of Dexmedetomidine and Propofol in Cardiac Surgery Background Awareness during general anesthesia is undesired and unanticipated patient wakefulness during surgery or recall of intraoperative events. Incidence of awareness in patients undergoing cardiac surgery is significantly higher than the overall incidence of 1% during general surgery. Awareness during cardiac surgery can be prevented by a number of methods. One such method (...) is the supplemental, intraoperative use of sedative agents. Propofol, a bisubstituted phenol, is an intravenous general anesthetic that has been shown to reduce the incidence of awareness. Dexmedetomidine-an alpha2-adrenergic agonist with anxiolytic, opioid, and general anesthetic-sparing properties-is being considered for maintaining intraoperative depth of anesthesia. The purpose of this study was to evaluate the effect of dexmedetomidine on depth of anesthesia and to compare it with the effect of propofol

2017 Cureus Controlled trial quality: uncertain PubMed abstract

30. Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery (Full text)

Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study (...) was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep.Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory

2017 Oncotarget PubMed abstract

31. Effects of different methods of general anesthesia on intraoperative awareness in surgical patients. (Full text)

Effects of different methods of general anesthesia on intraoperative awareness in surgical patients. The purpose of the study was to investigate the effects of total intravenous anesthesia (TIVA) and combined of intravenous and inhaled anesthesia (CIIA) on intraoperative awareness in surgical patients.A total of 678 patients were recruited in the CIIA group, while TIVA group included 566 patients. The clinical characteristics and the occurrence of intraoperative awareness were compared between (...) the groups. Mini-Mental State Examination, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 tests were performed to estimate cognitive and psychological functions of the patients. In addition, logistic regression analysis was applied to identify the risk factors for intraoperative awareness in surgical patients.In CIIA group, 3 patients (0.44%) were confirmed with intraoperative awareness, while 11 patients (1.94%) in TIVA group underwent intraoperative awareness. The occurrence rate

2017 Medicine PubMed abstract

32. Systematic review and meta analysis of the incidence of accidental awareness during general anaesthesia in adult patients (18 years and over) as detected by the Brice questionnaire (including variants)

Systematic review and meta analysis of the incidence of accidental awareness during general anaesthesia in adult patients (18 years and over) as detected by the Brice questionnaire (including variants) Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files

2018 PROSPERO

33. Does post-operative knee awareness differ between knees in bilateral simultaneous total knee arthroplasty? Predictors of high or low knee awareness. (Abstract)

Does post-operative knee awareness differ between knees in bilateral simultaneous total knee arthroplasty? Predictors of high or low knee awareness. To evaluate the difference in post-operative knee awareness between knees in patients undergoing bilateral simultaneous total knee arthroplasty (TKA) and to assess factors predicting high or low knee awareness.This study was conducted on 99 bilateral simultaneous TKAs performed at our institution from 2008 to 2012. All patients received one set (...) of questionnaires [Forgotten Joint Score (FJS) and Oxford Knee Score (OKS)] for each knee. Based on the FJS, the patients' knees were divided into two groups: "best" and "worst" knees. The median of the absolute difference in FJS and OKS within each patient was calculated. Multivariate linear regression was performed to identify factors affecting FJS.The difference between knees was 1 point (CI 0-5) for the FJS and 1 point (CI 0-2) for the OKS. The FJS for females increased (decreasing awareness

2016 Knee Surgery, Sports Traumatology, Arthroscopy

34. Patient perspectives on intraoperative awareness with explicit recall: report from a North American anaesthesia awareness registry. (Full text)

Patient perspectives on intraoperative awareness with explicit recall: report from a North American anaesthesia awareness registry. Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended awareness from the patient's perspective with an emphasis on their experiences and healthcare provider responses.English-speaking subjects self-reported explicit recall (...) of events during anaesthesia to the Anesthesia Awareness Registry of the ASA, completed a survey, and submitted copies of medical records. Anaesthesia awareness was defined as explicit recall of events during induction or maintenance of general anaesthesia. Patient experiences, satisfaction, and desired practitioner responses to explicit recall were based on survey responses.Most of the 68 respondents meeting inclusion criteria (75%) were dissatisfied with the manner in which their concerns were

2015 British Journal of Anaesthesia PubMed abstract

35. Perioperative care in adults

surgery, including dental surgery. Discuss the person's risks and surgical options with them to allow for informed shared decision making. 1.3.2 Discuss lifestyle modifications with people having surgery, for example stopping smoking and reducing alcohol consumption. Follow the relevant NICE guidance on lifestyle and wellbeing. Preoperative optimisation clinics for older people Preoperative optimisation clinics for older people 1.3.3 Be aware that there was not enough clear evidence to show whether (...) the recommendations on intravenous and oral iron in the NICE guideline on blood transfusion. Oral iron regimens Oral iron regimens 1.3.5 Consider an alternate-day oral iron regimen for people who have side effects from taking oral iron every day. When to start oral iron supplementation When to start oral iron supplementation 1.3.6 Be aware that there was no evidence comparing different starting times for iron supplementation, so the committee made a recommendation for research. Medicines adherence Medicines

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

36. PulmoVista 500 for monitoring ventilation in critical care

the technology similar to other EIT devices. One was not aware of any comparators and another felt the technology bridged a gap in current standard of care imaging. P Potential patient impact otential patient impact Three specialists believed the technology could help inform the optimal settings for mechanical ventilation but 2 commented that more evidence is needed in this area. Two commented that the technology allows for non-invasive monitoring of a section of the lungs. One felt it would be useful

2020 National Institute for Health and Clinical Excellence - Advice

37. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. (Abstract)

Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. At April 2020, this review has been withdrawn. It is correct at the date of publication, and previous versions can be accessed in the 'Other versions' tab on the Cochrane Library. We are aware of new studies to potentially change the conclusions, however the update did not meet the timelines and expectations of Cochrane and the PaPaS review group.Copyright © 2020 The Cochrane Collaboration. Published

2020 Cochrane

38. Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events

% and in cardiac disease 24.6% vs. 15.7% (p=0001) Patients with neurological insults were less likely to receive ketamine 22.8% vs. 9.5% III. Did experimental and control groups retain a similar prognosis after the study started (answer the questions posed below)? 1. Were patients aware of group allocation? No. 2. Were clinicians aware of group allocation? Yes. Clinicians selected their induction a agents of choice. 3. Were outcome assessors aware of group allocation? Yes. There is no mention whether data

2020 Emergency Medicine Journal Club

39. Advice for pregnant members of the anaesthesia and intensive care workforce during the COVID-19 pandemic

weeks) are more likely to become seriously unwell. This may also lead to preterm birth of their baby, intended to enable the woman to recover through improving the efficiency of her breathing or ventilation. 3,45 Given these additional considerations for pregnant women who become seriously unwell in the later stages of pregnancy, the Government has taken the precautionary approach to include pregnant women in a vulnerable group. This is so that pregnant women are aware of the current lack (...) of available evidence relating to this virus in pregnancy; and particularly, to encourage awareness that pregnant women in later stages of pregnancy could potentially become more seriously unwell. 2.2 Risk to the baby Currently, there is no evidence to suggest that COVID-19 causes problems with a baby’s development or causes miscarriage. With regard to vertical transmission (transmission from woman to baby antenatally or intrapartum), emerging evidence now suggests that vertical transmission is probable

2020 ICM Anaesthesia COVID-19

40. Evidence Brief: Capnography for Moderate Sedation in Non-Anesthesia Settings

that baseline systolic blood pressure was higher in the EGD capnography blinded group versus open group, more patients’ data were excluded from the capnography group than the routine monitoring group (8 vs 1 patient), and outcome assessors were aware of what group patients were assigned to. The main limitation of the RCT 26 examining ERCP and EUS was that outcome assessors were aware of what group patients were assigned to. Two prospective observational studies 15,27 (total n=1,015) provide data (...) by capnography. Additional limitations of the study were that outcome assessors were aware of what group patients were in, and there was no information on the number of patients who were approached for or were otherwise eligible for the study compared to the number who enrolled. One additional retrospective observational study 4 (n=5,446) evaluated sedation-related complications in a large series of patients undergoing endoscopic procedures either monitored by capnography or routine monitoring. However

2020 Veterans Affairs Evidence-based Synthesis Program Reports

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