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41. 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

42. 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

43. 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

44. Ketamine Procedural Sedation for Children in EDs

therapy. Ketamine’s unique profile means the emergency physician must be aware of both the challenges and benefits of using ketamine. Probably the most challenging is the relatively common and well recognised agitation (with or without hallucinations) that can occur during the recovery period. In addition, children may experience nightmares following ketamine procedural sedation, although this is transient and will have no long lasting effects. Clinicians therefore must have experience of using (...) ketamine for sedation in the ED, be aware of these and other potential side effects, and be in a position to confidently treat them where necessary. Parents must be made aware of possible delayed effects (in writing) and be advised to return to the ED if concerned. Ketamine is fundamentally different from other procedural sedation agents, and does not conform to the continuum tenet. Arguably this increases its attraction for the clinician. Dissociation is either present or absent, with a narrow

2020 Royal College of Emergency Medicine

45. Protocolised non-invasive compared with invasive weaning from mechanical ventilation for adults in intensive care: the Breathe RCT Full Text available with Trip Pro

be aware of any competing interests (conflicts of interest). The International Committee of Medical Journal Editors (ICMJE) define competing interests as including: financial relationships with industry (for example through employment, consultancies, stock, ownership, honoraria, and expert testimony), either directly or through immediate family; personal relationships; academic competition; and intellectual passion. If yes, please provide details below Enter response title * Enter CAPTCHA What is three

2019 NIHR HTA programme

46. Alerting thresholds for the prevention of intraoperative awareness with explicit recall: A secondary analysis of the Michigan Awareness Control Study. Full Text available with Trip Pro

Alerting thresholds for the prevention of intraoperative awareness with explicit recall: A secondary analysis of the Michigan Awareness Control Study. Intraoperative awareness with explicit recall is a potentially devastating complication of surgery that has been attributed to low anaesthetic concentrations in the vast majority of cases. Past studies have proposed the determination of an adequate dose for general anaesthetics that could be used to alert providers of potentially insufficient (...) anaesthesia. However, there have been no systematic analyses of appropriate thresholds to develop population-based alerting algorithms for preventing intraoperative awareness.To identify a threshold for intraoperative alerting that could be applied for the prevention of awareness with explicit recall.Secondary analysis of a randomised controlled trial (Michigan Awareness Control Study).Three hospitals at a tertiary care centre in the USA.Unselected patients presenting for surgery under general

2014 European Journal of Anaesthesiology Controlled trial quality: uncertain

47. Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses. Full Text available with Trip Pro

Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses. The results of a recently performed randomized clinical trial showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness (BA), catastrophizing, and depression was improved by adding psychomotor therapy (PMT), an intervention targeting BA. No significant effects were found on quality of life and disability. The present follow-up study aimed

2015 Clinical Journal of Pain Controlled trial quality: uncertain

48. Modern Palliative Treatments for Metastatic Bone Disease: Awareness of Merits, Demerits and Guidance. (Abstract)

Modern Palliative Treatments for Metastatic Bone Disease: Awareness of Merits, Demerits and Guidance. Metastatic disease is the most common malignancy of the bone. Prostate, breast, lung, kidney, and thyroid cancer account for 80% of skeletal metastases. Bone metastases are associated with significant skeletal morbidity including severe bone pain, pathologic fractures, spinal cord or nerve roots compression, and malignant hypercalcemia. These events compromise greatly the quality of life

2015 Clinical Journal of Pain

49. Impact of race and sex on pain management by medical trainees: a mixed methods pilot study of decision making and awareness of influence. Full Text available with Trip Pro

Impact of race and sex on pain management by medical trainees: a mixed methods pilot study of decision making and awareness of influence. Previous research suggests female and black patients receive less optimal treatment for their chronic pain compared with male and white patients. Provider-related factors are hypothesized to contribute to unequal treatment, but these factors have not been examined extensively. This mixed methods investigation examined the influence of patients' demographic (...) characteristics on providers' treatment decisions and providers' awareness of these influences on their treatment decisions.Twenty medical trainees made treatment decisions (opioid, antidepressant, physical therapy) for 16 virtual patients with chronic low back pain; patient sex and race were manipulated across patients. Participants then indicated from a provided list the factors that influenced their treatment decisions, including patient demographics. Finally, individual interviews were conducted

2015 Pain Medicine

50. Intraoperative awareness risk, anesthetic sensitivity, and anesthetic management for patients with natural red hair: a matched cohort study. Full Text available with Trip Pro

Intraoperative awareness risk, anesthetic sensitivity, and anesthetic management for patients with natural red hair: a matched cohort study. The red-hair phenotype, which is often produced by mutations in the melanocortin-1 receptor gene, has been associated with an increase in sedative, anesthetic, and analgesic requirements in both animal and human studies. Nevertheless, the clinical implications of this phenomenon in red-haired patients undergoing surgery are currently unknown.In a secondary (...) analysis of a prospective trial of intraoperative awareness, red-haired patients were identified and matched with five control patients, and the relative risk for intraoperative awareness was determined. Overall anesthetic management between groups was compared using Hotelling's T(2) statistic. Inhaled anesthetic requirements were compared between cohorts by evaluating the relationship between end-tidal anesthetic concentration and the bispectral index with a linear mixed-effects model. Time

2015 Canadian Journal Of Anaesthesia Controlled trial quality: uncertain

51. Awareness during emergence from anaesthesia: significance of neuromuscular monitoring in patients with butyrylcholinesterase deficiency†. Full Text available with Trip Pro

Awareness during emergence from anaesthesia: significance of neuromuscular monitoring in patients with butyrylcholinesterase deficiency†. Butyrylcholinesterase deficiency can result in prolonged paralysis after administration of succinylcholine or mivacurium. We conducted an interview study to assess whether patients with butyrylcholinesterase deficiency were more likely to have experienced awareness during emergence from anaesthesia if neuromuscular monitoring had not been applied.Patients (...) referred during 2004-2012 were included. Data on the use of neuromuscular monitoring were available from a previous study. Interviews, conducted by telephone, included questions about awareness and screening for post-traumatic stress disorder. Reports of panic, hopelessness, suffocation, or a feeling of being dead or dying resulted in the experience being classified further as distressful. Patients were categorized as aware or unaware by investigators blinded to use of neuromuscular monitoring.Ninety

2015 British Journal of Anaesthesia

52. Intraoperative awareness: controversies and non-controversies. Full Text available with Trip Pro

Intraoperative awareness: controversies and non-controversies. Intraoperative awareness, with or without recall, continues to be a topic of clinical significance and neurobiological interest. In this article, we review evidence pertaining to the incidence, sequelae, and prevention of intraoperative awareness. We also assess which aspects of the complication are well understood (i.e. non-controversial) and which require further research for clarification (i.e. controversial). © The Author 2015

2015 British Journal of Anaesthesia

53. Best Practice in the Management of Epidural Analgesia in the Hospital Setting

surgery or trauma to the chest, abdomen, pelvis or lower limbs. It provides excellent pain relief with high patient satisfaction when compared with other methods of analgesia and may avoid side effects associated with systemic therapy. However, epidural analgesia can cause serious, potentially life-threatening complications and all practitioners should be aware of these. Safe and effective epidural management requires a co-ordinated multidisciplinary approach (1, 2). 1.2 This document is a revised (...) to chlorhexidine is present. Practitioners should be aware of the risks and benefits of all skin antiseptic preparations (including the various concentrations available). 5.3 The tip of the epidural catheter should be positioned at a spinal level appropriate for the surgery. The catheter should be secured in order to minimise movement in or out of the epidural space. A sterile dressing should allow easy visibility of the insertion site and catheter. 5.4 Anaesthetists inserting epidural catheters should

2020 Faculty of Pain Medicine

54. Is the Level of Sedation Depth in the Early Postintubation Period Associated With Worse Patient Outcomes? Full Text available with Trip Pro

crowding have led to increased management of these patients in the ED setting, it is important to be aware of the risks of light versus deep sedation in their early management. The authors of this study identified that light sedation in the early period (defined as within 48 hours) was associated with reduced mortality, length of ICU stay, and number of days of mechanical ventilation. From a practical standpoint, providers could achieve this by using standardized protocols with sedation goals based

2019 Annals of Emergency Medicine Systematic Review Snapshots

55. Checklist for draw-over anaesthetic equipment

for all users. Common pitfalls • Awareness of anaesthetic agent levels in vaporiser due to rapid use • Multiple connections within the breathing system means there is a high risk of disconnection • Heavy valve/?lter arrangement at patient end of circuit • Putting supplementary oxygen connection distal to the vaporiser in the circuit can lead to dilution of the volatile • Ensure vaporiser cap is ?tted properly • Failed removal of expired gases - especially when using PEEP • Lack of temperature (...) public awareness and are at the forefront of safer anaesthesia across the world. Published by Association of Anaesthetists 21 Portland Place, London, W1B 1PY Telephone 020 7631 1650 Fax 020 7631 4352 info@anaesthetists.org www.anaesthetists.org Association of Anaesthetists is the brand name used to refer to both the Association of Anaesthetists of Great Britain & Ireland and its related charity, AAGBI Foundation (England & Wales no. 293575 and in Scotland no. SC040697).

2020 Association of Anaesthetists of GB and Ireland

56. Guideline on the role of the anaesthetist in commissioning medical gas pipelines (PILOT)

/oxygen 50/50 • Variable air/oxygen mixtures (rarely reticulated) • Oxygen/helium mixtures (oxygen =20%) (rarely reticulated) • Carbon monoxide in air (n.b. this is a NIST fitting) • Anaesthetic gas scavenging • Suction Figure 2. Example of tool for testing gas-specific connection at the terminal unit 10. Use of terminal units following works involving pipelines and terminal units Anaesthetists should be aware that terminal units in areas with nitrous oxide, carbon dioxide and other asphyxiating gases

2020 Australian and New Zealand College of Anaesthetists

57. Anaesthesia and sedation in breastfeeding women

continually improve standards of patient safety. We preserve and learn from the history of anaesthesia. We use that to inform the present, and facilitate vital research and innovation into its future. As an independent organisation, we speak up freely and openly for the interests of anaesthetists and their patients. We influence policy, raise public awareness and are at the forefront of safer anaesthesia across the world. Published by Association of Anaesthetists 21 Portland Place, London, W1B 1PY

2020 Association of Anaesthetists of GB and Ireland

58. Guideline on the role of anaesthetists in commissioning medical gas pipelines

• Variable air/oxygen mixtures (rarely reticulated) • Oxygen/helium mixtures (oxygen =20%) (rarely reticulated) • Carbon monoxide in air (n.b. this is a NIST fitting) • Anaesthetic gas scavenging • Suction Figure 2. Example of tool for testing gas-specific connection at the terminal unit 10. Use of terminal units following works involving pipelines and terminal units Anaesthetists should be aware that terminal units in areas with nitrous oxide, carbon dioxide and other asphyxiating gases should

2020 Australian and New Zealand College of Anaesthetists

59. Vital Signs in Anaesthesia A guide for anaesthetists seeking help and advice during the COVID crisis

, dislikes and ways of coping with stress and conflict. Their personas may be armoured to cope with the job, but they will be feeling the full range of human emotions too. If these are unbearable, or just difficult, they can be suppressed. In this case, doctors may not be consciously aware of these emotions, but they are still there. All doctors at times feel anxious, frightened, depressed, deluded, suspicious, bad tempered, irritable, bored, martyred, unappreciated, bullied, tired, taken for granted (...) for our physical safety’. Attending to basic physical and mental needs is the first step to improving wellbeing. The key is to develop a good degree of self-awareness and recognise when we are overstretched and overstressed. Under pressure we need to adopt strategies that improve our resilience and performance. Stacey proposes some strategies in a toolkit which addresses and highlights sleep, exercise and meditation [10]. Suicide appears to be more prevalent amongst anaesthetists. A recent survey

2020 Association of Anaesthetists of GB and Ireland

60. Perioperative

this communicated to the surgical and anesthesiology team and the patient made aware this may increase the surgical risk. Consensus Chung, 2016 (Guideline); Gross, 2014 (Guideline) Nicotine Cessation Low Smoking cessation intervention (brief or intensive) should be initiated before elective surgery. Strong Bayfield, 2018 (Meta- Analysis); Nolan, 2017 (Observational Study); Nolan, 2015 (Systematic Review); Thomsen, 2014 (Systematic Review) Return to Table of Contents Recommendations Tablewww.icsi.org Institute (...) the recovery from anesthesia or sedation. 3. Patients with suspected sleep apnea in the perioperative period should have a follow-up evaluation, typically in concert with the patient’s primary provider (if one is available), and/or referral to sleep center. 4. Patients with known sleep apnea or suspected sleep apnea at a preoperative evaluation should have this communicated to the surgical and anesthesiology team, and the patient made aware this may increase the surgical risk. Benefit: Targeted screening

2020 Institute for Clinical Systems Improvement

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