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1.
The first 150 words of the full text of this article appear below. Key points Scoliosis is most commonly idiopathic in origin,but it may be congenital or secondary to neuromuscular disease,trauma, infection or neoplasm. Surgery aims to correct thecurvature, improve posture and reduce progression of respiratorydysfunction. Cardio-respiratory dysfunction may exist as aresult of progressive scoliosis or be related to coexistingdisease, therefore careful preoperative assessment is required. Intraoperativeconsiderations include the prone position, avoiding hypothermia,minimizing blood loss and monitoring spinal cord function. Goodpostoperative pain control is essential and requires a multimodalapproach. Scoliosis is a lateral curvature and rotation of the thoraco-lumbarvertebrae with a resulting rib cage deformity. It may be idiopathicor secondary to neuromuscular disease, infection, tumour orinjury (Table 1).
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Table 1 Classification of scoliosis aetiology
Curvature is measured using the Cobb angle (Fig. 1). A lateralcurve of >10° is considered abnormal.1 相似文献
2.
Nosocomial infections 总被引:1,自引:0,他引:1
Nosocomial infections can be defined as those occurring within48 hours of hospital admission, 3 days of discharge or 30 daysof an operation. They affect 1 in 10 patients admitted to hospital.Annually, this results in 5000 deaths with a cost to the NationalHealth Service of a billion pounds. On average, a patient withhospital acquired infection spent 2.5-times longer in hospital,incurring additional costs of £3000 more than an uninfectedpatient. Intensive care units (ICU) have the highest prevalenceof hospital-acquired infections in the hospital setting. TheEuropean Prevalence of Infection in Intensive Care Study (EPIC),involving over 4500 patients, demonstrated that the nosocomialinfection prevalence rate in ICU was 20.6%.1 ICU patients areparticularly at risk from nosocomial infections as a resultof mechanical ventilation, use of invasive procedures and theirimmunocompromised status (Table 1).
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Table 1 Factors that predispose to nosocomial infections.
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3.
Richardson J 《British journal of anaesthesia》2004,93(2):173-174
Anaesthetics is a broad field. Anaesthetists have provided thebasis for many advances in surgical techniques and improvementin outcomes, while allowing ever more traditionally unfit patientsto be treated. Not satisfied with that, we expand ever moreinto the field of surgical pathology, co-developing minimallyinvasive alternative treatments. There are many examples inthe field of chronic spinal pain (Table 1).
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Table 1 Pain generating anatomical spinal structure,1618 with the possible surgical and minimally invasive treatment
Igarashi and colleagues, in this issue,1 do not claim 相似文献
4.
The Jehovah's Witness religion is a Christian movement, foundedin the US in the 1870s, with 6 million members worldwide (150,000in the UK). Members of this faith have strong beliefs basedupon passages from the Bible that are interpreted as prohibitingthe consumption of blood. Their beliefs preventthem from accepting transfusion of whole blood or its primarycomponents. They also believe that blood that has been removedfrom the body is unclean and should be disposedof. The use of procedures that involve the removal and storageof their own blood are often unacceptable (Table 1).
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Table 1 Acceptability of blood products and transfusion-related procedures in Jehovah's Witnesses
Blood-free major surgery in the Jehovah's Witness patient presentsa challenge to the anaesthetic and surgical team. The problemsassociated with their management highlights a growing health-careissue the supply, safety and appropriate use of bloodproducts. Techniques learnt from treating them may prove beneficialto all patients undergoing major surgery. 相似文献
5.
The neuroendocrine, metabolic and inflammatory aspects of injuryare part of the overall stress response (Table 1).This has been studied most commonly in relation to surgery,because the catabolic changes that occur can be observed froma well-defined starting point, but similar features occur intrauma, burns, severe infection and strenuous exercise. Theseresult in substrate mobilization, muscle protein loss and sodiumand water retention, with suppression of anabolic hormone secretion.There is activation of the sympathetic nervous system and immunologicaland haematological changes. Generally, the magnitude of themetabolic response is proportional to the severity of the surgicaltrauma. These changes have probably evolved to aid survivalin a more primitive environment, by mobilizing substrates, limitingtissue damage, destroying infectious organisms and activatingrepair processes. Psychological and behavioural changes accompanythe physiological events. The benefits of the stress responseare not obvious in modern medicine, when physiological changescan be more easily corrected and it may even have a detrimentaleffect. In recent years, research has focused on methods tomodify the response associated with surgery in an attempt toimprove patient outcome.
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Table 1 Changes occurring during the stress response
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6.
EditorWe were interested to read the short communicationregarding residual neuromuscular block after atracurium administrationby McCaul and colleagues.1 We have recently conducted a similarsurvey in our hospital, based on the work by Hayes and colleagues.2We measured the train-of-four ratio (TOFR) in adult patientsin our recovery ward using a Datex Ohmeda Accelerometer. Theproject was performed without the knowledge of the patientsanaesthetist, in an attempt to avoid a change in their usualclinical practice. We recorded type and dose of neuromuscularblocking agent, the timing and doses of increments, whetherantagonism was given, and whether a peripheral nerve stimulator(PNS) was used (Table 1).
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Table 1 Patient characteristics. Values are absolute (n) or 相似文献
7.
EditorThe Cobra Perilaryngeal Airway (PLA)TM is a newsupraglottic device,1 which consists of a tube with an inflatablecuff and a 15 mm standard adaptor. The softened distal end (CobraPLATMhead) of the breathing channel is designed to be positionedin the hypopharynx, opposite the laryngeal inlet, to divertthe inspiratory gas into the trachea through the slotted openings(Fig. 1).
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Fig 1 The CobraPLATM.
Ethics committee approval and written informed consent was obtainedfrom the patients before 相似文献
8.
The first 150 words of the full text of this article appear below. Key points The pathophysiology of neuropathic pain is complex. Treatmentof neuropathic pain is often poorly understood by healthcareprofessionals and consequently not managed well. The mainstayof therapy is tricyclic anti-depressants and anti-epilepticdrugs. Strong opioids have a role in some patients.
Neuropathic pain
Historically, neuropathic pain (NeP) has proved to be a difficultproblem to manage; this has stemmed from a lack of knowledgeof the pathophysiology of the disorder, coupled with a deficiencyof effective remedies. NeP affects a significant proportionof the population (>500 000 people in the UK) and lack ofappropriate treatment can be devastating, both in terms of patientquality of life and economic burden.1 The pathophysiology of NeP is complex and not fully understood.2It is very different from that of nociceptive or somatic painwhere the initial stimulus of the peripheral nociceptor is producedchemically as a result of tissue damage. NeP results . . . [Full Text of this Article]
First-line treatment