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81. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡ Full Text available with Trip Pro

5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡ The 5th National Audit Project (NAP5) of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland into accidental awareness during general anaesthesia (AAGA) yielded data related to psychological aspects from the patient, and the anaesthetist, perspectives; patients' experiences ranged (...) from isolated auditory or tactile sensations to complete awareness. A striking finding was that 75% of experiences were for <5 min, yet 51% of patients [95% confidence interval (CI) 43-60%] experienced distress and 41% (95% CI 33-50%) suffered longer term adverse effect. Distress and longer term harm occurred across the full range of experiences but were particularly likely when the patient experienced paralysis (with or without pain). The patient's interpretation of what is happening at the time

2014 British Journal of Anaesthesia

82. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors†‡ Full Text available with Trip Pro

5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors†‡ We present the main findings of the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia (AAGA). Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases (...) was ~1:19,600 anaesthetics (95% confidence interval 1:16,700-23,450). However, there was considerable variation across subtypes of techniques or subspecialities. The incidence with neuromuscular block (NMB) was ~1:8200 (1:7030-9700), and without, it was ~1:135,900 (1:78,600-299,000). The cases of AAGA reported to NAP5 were overwhelmingly cases of unintended awareness during NMB. The incidence of accidental awareness during Caesarean section was ~1:670 (1:380-1300). Two-thirds (82, 66%) of cases

2014 British Journal of Anaesthesia

83. Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness: A Cluster-randomized Trial. Full Text available with Trip Pro

Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness: A Cluster-randomized Trial. Because of methodological flaws and a lack of theoretical foundation of body awareness (BA) in previous effect studies of interventions directed to stimulate BA, it is impossible to attribute treatment effects to this specific component of a multidisciplinary treatment. Therefore, this study evaluated short-term and long-term effects of a multidisciplinary pain rehabilitation

2014 Clinical Journal of Pain Controlled trial quality: predicted high

84. Assessment of Patients' Awareness and Factors Influencing Patients' Demands for Sedation in Endodontics. (Abstract)

Assessment of Patients' Awareness and Factors Influencing Patients' Demands for Sedation in Endodontics. Endodontic therapy is perceived by many as a procedure to be feared. Many studies have reported that fear and anxiety are major deterrents to seeking dental care in general, but only a few deal with the use of sedation in endodontic therapies. The purpose of this study was to assess patients' awareness of and factors influencing the potential demand for sedation in endodontics. We

2014 Journal of Endodontics

85. Psychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials. Full Text available with Trip Pro

Psychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials. Elective surgery can have long-term psychological sequelae, especially for patients who experience intraoperative awareness. However, risk factors, other than awareness, for symptoms of posttraumatic stress disorder (PTSD) after surgery are poorly defined, and practical screening methods have not been applied to a broad population of surgical patients.The Psychological (...) Sequelae of Surgery study was a prospective cohort study of patients previously enrolled in the United States and Canada in 3 trials for the prevention of intraoperative awareness. The 68 patients who experienced definite or possible awareness were matched with 418 patients who denied awareness based on age, sex, surgery type, and awareness risk. Participants completed the PTSD Checklist-Specific (PCL-S) and/or a modified Mini-International Neuropsychiatric Interview telephone assessment to identify

2014 Anesthesia and Analgesia

86. Bupivacaine liposome injectable suspension (Exparel Pacira Pharmaceuticals Inc.) for treatmentof postoperative pain in abdominal surgeries

adequate postoperative pain relief. Increasing awareness of issues on the safety of opioids has prompted a focus on best practices in multimodal analgesic regimens. For postoperative use, traditional local anesthetics are limited by their short duration of action. Description of Technology: Exparel is a liposome injection of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia. Liposome preparations increase the duration of action of local

2017 Health Technology Assessment (HTA) Database.

87. Pediatric Home Mechanical Ventilation

, telemedicine, home visits, clinic visits, and visits during hospitalizations for intercurrent illnesses. The family therefore needs to be aware of the follow-up care plan, which will depend on the child’s status and needs, and coordinated with other consultants following the child. Furthermore, family caregivers need to continue to receive ongoing tracheostomy and ventilator skills assessmentsandretraining. 3. School: Many children with a tracheostomy and invasive HMV attend school. An emergency plan needs (...) .(Consensus) 4. The patient should be medically stable with a need for a level of monitoring or treatment interventions that canbemanagedathome.(Consensus) 5. The patient and the family must be highly motivated. (Consensus) a. The family is willing/able to ensure provision of “24/ 7 eyes on care” for all invasively ventilated children andforchildrenreceivingNIVthataredeemedmed- ically fragile and in need of this level of care at home. b. The family is aware that the discharge destination is home,notalong

2017 Canadian Thoracic Society

88. The Epidrum for aiding access to the epidural space

. Ultrasound imaging can be used to either guide the epidural needle into the epidural space (in real-time) or provide information on the regional anatomy before inserting the epidural needle into the epidural space (prepuncture ultrasound). NICE is aware of the following CE-marked devices that appear to fulfil a similar function to the Epidrum: the Episure AutoDetect LOR syringe (Indigo Orb) the Epimatic (Vygon). Costs and use of the technology The manufacturer states that the Epidrum is available (...) ), patients were matched for age, gender, height and weight, and in the study by Sawada et al. (2012) they were additionally matched for the spinal level at which the epidural was inserted. However, it is unclear if other confounding factors were equally balanced across the groups. As a result, selection bias cannot be excluded. Patient and investigator blinding (that is, not being aware of which treatments are being assigned) is especially important when the outcome measures are subjective, such as user

2015 National Institute for Health and Clinical Excellence - Advice

89. Guidelines on the Prevention of Postoperative Vomiting in Children

that omission of nitrous oxide reduced the incidence of postoperative vomiting but not nausea in high-risk patients with a NNT of 5. The reduction in emesis, by avoiding nitrous oxide, was achieved at the cost of an increased risk of intraoperative awareness 30 . In children, avoiding nitrous oxide has conflicting effects on POV; it produces a small reduction in early POV following dental surgery but not after grommet insertion without any difference in late POV rates with either procedure 31,32 (...) (5): 592-3 30. Tramèr M, Moore A, McQuay H. Omitting N 2 0 in general anaesthesia: meta-analysis of intraoperative awareness & postoperative emesis in randomised controlled trials. Brit J Anaesth 1996; 76: 186-193 31. Splinter WM, Komocar L. N 2 0 does not increase vomiting after dental restorations in children. Anesth Analg 1997; 84(3): 506-508 32. Splinter WM, Roberts DJ, Rhine EJ et al. N 2 0 does not increase vomiting in children after myringotomy. Can J Anaesth 1995;42: 274-6 33. Pandit UA

2017 Association of Paediatric Anaesthetists of Great Britain and Ireland

90. An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial) Full Text available with Trip Pro

these using commas Statement of competing interests We believe that readers should 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

2016 NIHR HTA programme

91. Guidelines for the Safe Management and Use of Medications in Anaesthesia Background Paper

coding for different routes and compliance with Labelling Standards is required in Australia. With the coming introduction of the new small bore neuraxial standard the likelihood of such misconnections should be diminished. Infusion devices with Dosage Error Reduction Software may offer a safety benefit 5 . 3.2.4 Patient identification and “open” versus “closed” practice environments. Anaesthetists must be aware of the difference between an open and closed practice environment

2017 Australian and New Zealand College of Anaesthetists

92. Guidelines for the Safe Management and Use of Medications in Anaesthesia

of 'medication errors' range from 1 in 20 administration events 1 , to 1 in 133 2 anaesthesia episodes. Many of these reported events were protocol or process errors (including mislabelling or omission of an appropriate drug), however a proportion of these errors will result in an adverse event for the patient. More than 3 million anaesthetics are administered in Australia and New Zealand annually suggesting a substantial contribution to iatrogenic adverse events. Anaesthetists must be aware (...) anaesthesia should have a comprehensive understanding of the systems and processes involved in drug prescription and administration, including awareness of relevant legislation in the jurisdiction of practice. 4.4 Medical practitioners providing anaesthesia should have an awareness of the contribution of human factors to medication errors and take steps to manage these 3 . 4.5 Collaboration with hospital pharmacists and medication safety groups will assist in ensuring appropriate availability and safe

2017 Australian and New Zealand College of Anaesthetists

93. Guidelines on Monitoring During Anaesthesia Background Paper

contributes to improved quality care and outcomes. Vigilance and situational awareness cannot be replaced by monitoring equipment and the purpose of the equipment is to confirm changes in clinical status, but also to signal changes earlier. Consequently, monitoring is essential to management of anaesthesia with specific regard to optimising outcomes. The accompanying guidelines recommend that circulation, ventilation and oxygenation are monitored as a minimum and that other monitors should be added (...) of a life threatening airway condition, extremely brief paediatric procedure). In all such cases blood pressure monitoring should be initiated if and when circumstances permit. Neuromuscular blockade monitoring This is an emerging area of standardisation due to the awareness of the risk of residual curarisation. Guidelines such as the AAGBI (2015) provide excellent background and have moved towards mandating assessment of NMB; however the AAGBI Appendix does not consider suxamenthonium and emergency

2017 Australian and New Zealand College of Anaesthetists

94. Guidelines on Monitoring During Anaesthesia

indicated, equipment to monitor the anaesthetic effect on the brain should be available for use on patients, especially those at high risk of awareness, during general anaesthesia. 6.5. Inhalational anaesthetic agent monitor - to identify and monitor the inspired and end-tidal concentration of inhalational anaesthetics must be in use for every patient undergoing general anaesthesia from an anaesthesia delivery system where inhalational anaesthetic agents are delivered. 6.6. Temperature monitor

2017 Australian and New Zealand College of Anaesthetists

95. Research Fails to Provide Recommended Limit of Epinephrine in Local Anesthetics Used in Cardiovascular-Compromised Patients for Dental Procedures

and stress during a dental procedure for cardiovascular patients undergoing dental treatment in order to decrease the amount of endogenous epinephrine released. There is not sound research supporting the threshold of epinephrine use in cardiac patients, mostly because it would be unethical to subject patients of a toxic dose of epinephrine. Lastly, the ischemic changes seen are not life threatening, but the dentist should still be aware. Best Evidence (you may view more info by clicking on the PubMed ID

2017 UTHSCSA Dental School CAT Library

97. Epidural anaesthesia helps return of bowel function after abdominal surgery

treatment allocation, and patients and assessors being aware of pain-relief given. Only six were conducted in the UK. What did it find? High quality evidence from 22 trials (1,138 participants) found an epidural containing local anaesthetic decreased the time to return of gut function by approximately 17.5 hours compared with an opioid-based regimen (standardised mean difference [SMD] -1.28, 95% CI -1.71 to -0.86). There was high variability in the results of the individual studies, but subgroup (...) to 72-hours post-surgery, vomiting within 24 hours, leakage where bowel sections were joined, length of hospital stay and costs. The included trials were of mixed quality ranging from very low to high quality. Common sources of bias involved treatment allocation, and patients and assessors being aware of pain-relief given. Only six were conducted in the UK. What did it find? High quality evidence from 22 trials (1,138 participants) found an epidural containing local anaesthetic decreased the time

2019 NIHR Dissemination Centre

98. Two types of anaesthesia are safe for hip and knee replacements but one may reduce the time spent in hospital by a few hours

the spinal cord to numb the body from the waist down. Sedation is often used as well, to reduce anxiety and awareness of the operating room. This systematic review aimed to compare patient-important outcomes when total hip or knee replacements were performed either using general or neuraxial anaesthesia. What did this study do? This systematic review identified 19 randomised controlled trials and 10 prospective observational studies, with a total of 10,488 people. The studies compared outcomes in people (...) as to which technique is safer, more effective or less expensive. General anaesthesia renders the patient unconscious. Pain is managed with drugs such as morphine during and after the surgery. Neuraxial anaesthesia (spinal or epidural anaesthesia) involves administering a local anaesthetic around the spinal cord to numb the body from the waist down. Sedation is often used as well, to reduce anxiety and awareness of the operating room. This systematic review aimed to compare patient-important outcomes when

2019 NIHR Dissemination Centre

99. Consent for anaesthesia

treatment or appoint a proxy to decide upon their behalf using a lasting power of attorney (LPA). A valid and applicable advance decision or a decision ofavalidlyappointed health and welfare LPAisleg- ally binding, as is the decision of a court-appointed deputywith the appropriate powers. 11 Anaesthetists should be aware of the different frameworks that apply in relation to consent (and who can consent on behalf of the patient) with respect to patients aged 16 and 17 and those under 16. 12 When planning (...) should reasonably be aware that the particular patient would be likely to attach signi?cance to it” [10] – thus bringing the law in line with previous professional guidance from the GMC in 2008 [3, 14]. There are only three exceptions to this rule: i) the patient has expressed a ?xed desire not to know the risks; ii) discussion of the riskswould pose a serious threat (beyond merely causing distress) to the patient (e.g. suicide); and iii) in ‘circum- stances of necessity’ where urgent treatment

2017 Association of Anaesthetists of GB and Ireland

100. Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten): a multicentre, multinational feasibility study of fluorescence in predicting lymph node-positive disease Full Text available with Trip Pro

comment. Once published, you will not have the right to remove or edit your response. The Editors may add, remove, or edit comments at their absolute discretion. Enter response message * Name (title, first name, last name) * Occupation / Job title * Affiliation / Employer * Email * Other authors For example, if you are responding as a team or group. Please ensure you include full names and separate these using commas Statement of competing interests We believe that readers should be aware of any

2016 NIHR HTA programme

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