European journal of anaesthesiology
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Lumbar epidural anaesthesia induces cardiovascular changes and decreases liver blood flow (Qh). We studied the effects of age on haemodynamics, blood volumes and Qh before and after epidural anaesthesia. ⋯ Age increases the level of analgesia after epidural ropivacaine and is associated with a more pronounced decrease in arterial pressure. A colloid preload mildly increases haemodynamics, but this insufficiently prevents younger and elderly patients from a decrease in Qh after lumbar epidural anaesthesia.
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Conventional analgesics have limited efficacy in the management of neuropathic pain. An adjuvant analgesic is a drug that has a primary nonpain indication but which may be analgesic in certain circumstances, and many of these have established a role in the pharmacological treatment of neuropathic pain. ⋯ Cost-effectiveness data are absent for the vast majority of these drugs. Pharmacological treatments should be used as part of a multimodal therapeutic programme for the management of neuropathic pain.
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Randomized Controlled Trial
Delta sleep-inducing peptide alters bispectral index, the electroencephalogram and heart rate variability when used as an adjunct to isoflurane anaesthesia.
Delta sleep-inducing peptide (DSIP) is an endogenous peptide that crosses the blood-brain barrier, named after its association with natural sleep and enhanced electroencephalogram (EEG) delta rhythm. The objective of this study was to determine whether DSIP could be used as an adjunct to volatile anaesthesia in humans, our hypothesis being that DSIP is a natural hypnotic that would increase anaesthetic depth. The aims were to assess depth of anaesthesia using bispectral index (BIS), the EEG and heart rate variability (HRV), and to determine whether DSIP altered the symmetry of EEG between the left and right cerebral hemispheres. ⋯ DSIP probably reduced parasympathetic tone and decreased (lightened) the depth of anaesthesia measured using BIS.
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Pancuronium, vecuronium, mivacurium and rocuronium are nondepolarizing neuromuscular blocking agents, which are competitive antagonists against acetylcholine at nicotinic receptors, and considered to have no direct actions on vascular smooth muscle. We aimed to investigate the relaxant effects and possible underlying mechanisms of these agents on isolated rat thoracic aorta. ⋯ In conclusion, their relaxation effect may be due to an increase in prostaglandin synthesis. The increased relaxation effect of these agents at electrical field stimulation may be by the decreasing effect of noradrenaline reuptake from nerve endings because a noradrenaline reuptake inhibitor desipramine did not change this effect. Also, these neuromuscular agents may affect beta-receptors, because a nonselective beta-blocker agent, propranolol, decreased their electrical field stimulation-induced relaxations.
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Comparative Study
Teaching anaesthesia induction to medical students: comparison between full-scale simulation and supervised teaching in the operating theatre.
The aim of the study was to compare the effectiveness of teaching of general anaesthesia induction to medical students using either full-scale simulation or traditional supervised teaching with patients in the operating theatre. ⋯ The simulation group performed better in 25% of the tasks and similarly in the others compared with the traditional teaching group. With the same time and amount of teaching personnel we trained five or six students in the simulator compared with one student in the operating theatre. Further research will reveal whether these promising results with simulation may be applied more generally in anaesthesiology teaching to medical students.