Forumfor example, has been demonstrated by several yet only 65% of the patients in this survey were extended this simple courtesy. This figure is probably no worse than the national mean, yet if the anaesthetist seriously wishes to be thought of as a medical specialist rather than a technician, can he regard this as a satisfactory measure of his professional diligence ? Some practising anaesthetists are perhaps not doing full justice to the job that they were trained for, and, if their excuse is that they d o not have time, then perhaps their efforts should be directed less towards sacrificing their standards for the sake of convenience, and more towards insisting that they are given enough time for routine ward assessment.
SummaryDuring a single 5 day working week a series of adult National Health patients uiidergoing general anaesthesia for routine surgery a t a District General Hospital were interviewed on the day following the anaesthetic. Their experiences of anaesthesia, and their opinions of their anaesthetists are discussed.
Key words
Hyperosmolar solutions are widely used to treat raised intracranial pressure following severe traumatic brain injury. Although mannitol has historically been the most frequently administered, hypertonic saline solutions are increasingly being used. However, definitive evidence regarding their comparative effectiveness is lacking. The Sugar or Salt Trial is a UK randomised, allocation concealed open label multicentre pragmatic trial designed to determine the clinical and cost-effectiveness of hypertonic saline compared with mannitol in the management of patients with severe traumatic brain injury. Patients requiring intensive care unit admission and intracranial pressure monitoring post-traumatic brain injury will be allocated at random to receive equi-osmolar boluses of either mannitol or hypertonic saline following failure of routine first-line measures to control intracranial pressure. The primary outcome for the study will be the Extended Glasgow Outcome Scale assessed at six months after randomisation. Results will inform current clinical practice in the routine use of hyperosmolar therapy as well as assess the impact of potential side effects. Pre-planned longer term clinical and cost effectiveness analyses will further inform the use of these treatments.
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