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101. 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.

102. 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

103. Impact of Timing of Preprocedural Opioids on Adverse Events in Procedural Sedation (Abstract)

was statistically significantly associated with oxygen desaturation and vomiting (p < 0.0001) but not with PPV (p = 0.113).Timing of opioids was significantly associated with the risk of oxygen desaturation and vomiting. Being aware of this increased risk will help clinicians prepare for sedation and the potential need for patient rescue.© 2020 by the Society for Academic Emergency Medicine.

2020 EvidenceUpdates

104. 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

105. 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

107. 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

108. 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

109. 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

110. Guidelines on Pre-Anaesthesia Consultation and Patient Preparation

anaesthesia should be familiar with the principles outlined in the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia 1 and the New Zealand Medical Council’s Good Medical Practice 2 . There must also be an awareness of patient autonomy and patients’ rights to privacy as set out by the Privacy Act 1993 (NZ) 3 , the Privacy Act 1998 (Cth) 4 and the Privacy Amendment (Private Sector) Act 2000 (Cth) 5 . Supporting Anaesthetists’ Professionalism and Performance

2017 Australian and New Zealand College of Anaesthetists

111. 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

112. 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

113. Hydrogen Peroxide Bleaching Systems With Nano-Hydroxyapatite Do Not Significantly Reduce Postoperative Sensitivity Following Tooth Whitening Procedures

. Evidence Search PubMed: "Tooth Bleaching Agents"[Mesh] AND "Tooth Bleaching"[Mesh] AND "Bleaching Agents"[Mesh] AND "Tooth Discoloration"[Mesh] AND "Peroxides"[Mesh] Comments on The Evidence Compliance, completion rate, and follow-up were adequate for all the clinical trials. Both short term ( Applicability This evidence applies to healthy adult patients treated with in-office hydrogen peroxide containing tooth bleaching systems as well as at-home bleaching systems. Patients should be made aware

2017 UTHSCSA Dental School CAT Library

115. 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

116. 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

117. 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

118. Evaluation of a continuous monitoring and feedback initiative to improve quality of anaesthetic care: a mixed-methods quasi-experimental study Full Text available with Trip Pro

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 competing interests (conflicts of interest). The International Committee of Medical Journal Editors (ICMJE) define competing interests as including

2015 NIHR HTA programme

119. Effect of penehyclidine hydrochloride on the incidence of intra-operative awareness in Chinese patients undergoing breast cancer surgery during general anaesthesia. (Abstract)

Effect of penehyclidine hydrochloride on the incidence of intra-operative awareness in Chinese patients undergoing breast cancer surgery during general anaesthesia. Intra-operative awareness can lead to serious adverse psychological consequences. We conducted a prospective, randomised, double-blinded trial in 920 patients undergoing breast cancer surgery under bispectral index-guided total intravenous anaesthesia to evaluate the effect of penehyclidine hydrochloride on intra-operative awareness (...) . Patients were randomly divided to receive 0.01 mg.kg(-1) penehyclidine hydrochloride or saline intravenously 30 min before surgery. The pre-administration, pre-operative anxiety levels were assessed using a 100-mm visual analogue scale. Intra-operative awareness was defined as recall of intra-operative events using a modified Brice interview administered 2-6 h postoperatively, and in the next 24-48 h. A committee of three experts, blinded to the study conditions, independently scrutinised all reported

2013 Anaesthesia Controlled trial quality: uncertain

120. Situation Awareness in Anesthesia: Concept and Research. Full Text available with Trip Pro

Situation Awareness in Anesthesia: Concept and Research. Accurate situation awareness (SA) of medical staff is integral for providing optimal performance during the treatment of patients. An understanding of SA and how it affects treatment of patients is therefore crucial for patient safety and an essential element for research on human factors in anesthesia. This review describes the concept of SA in the anesthesia environment, including the interaction with associated medical teams. Different

2013 Anesthesiology

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