There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent.
Anaesthesiologists regularly request and administer blood components to their patients, a potentially life-saving intervention. All anaesthesiologists must be familiar with the indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematologists and their local haematology blood sciences laboratory is encouraged. In the last decade, there have been considerable changes in approaches to optimal use of blood components, together with the use of alternative products, with a need to update previous guidelines and adapt them for anaesthesiologists working throughout the hospital system.
Dexamethasone has an emerging role as an additive in regional anaesthesia for the management of acute pain. However, outcomes in terms of improvement and prolongation of analgesia, as well as the methods of administration and potential adverse effects, have yet to be clarified. This semi-structured review examines the current literature available with regard to supplemental dexamethasone in regional and neuraxial anaesthesia.
Introduction: Recent work into the causes of death after non-cardiac surgery has identified a new clinical concept, namely myocardial injury after non-cardiac surgery (MINS). The pathophysiology is related to a supply-and-demand mismatch in the peri-operative period and differs from the traditional model of myocardial ischaemia and infarction. Methods: Literature review of current body of knowledge and recent large multicentre clinical trials. Results: MINS is associated with increased morbidity and mortality at 30 days' post-surgery. A large international multicentre trial found that a troponin T level of greater than 0.3 ng/ml was associated with a mortality rate of 16.9%. Moreover, 84.2% of MINS would probably go undetected if systematic troponin monitoring after surgery was not performed. Conclusion: This review examines the current body of knowledge and provides practical guidelines on how to identify and manage patients with MINS.
IntroductionThe provision of adequate post-operative analgesia in patients undergoing knee arthroplasty presents a significant challenge. A multimodal approach to pain control in these patients has been commonly adopted with regimens including opioids, nonsteroidal anti-inflammatory drugs, adjuncts such as gabapentin or pregabalin, and the use of neuraxial and peripheral nerve blockade. Peri-articular injections and infusion of local anaesthetic holds great attraction as it provides localised analgesia without the side effects often seen with neuraxial or peripheral nerve blockade. This systematic review and meta-analysis aimed to determine whether, in adults undergoing knee arthroplasty, adding peri-articular local anaesthetic to a post-operative pain regimen improved post-operative pain scores.
AbstractBackground: This systematic review and meta-analysis aimed to quantify the effect of adding peri-articular local anaesthetic infiltration or infusion to an analgesic strategy in patients undergoing knee arthroplasty.
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