Anaesthesia
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This study examined the association between pressure pain sensitivity and various single nucleotide polymorphisms (SNPs) of human micro-, kappa-, and delta-opioid receptor (i.e. OPRM1, OPRK1, and OPRD1) genes in 72 healthy adult Taiwanese women of Han Chinese race. ⋯ Neither pressure pain threshold nor tolerance between major and minor alleles of other SNPs of the OPRM1, OPRK1, and OPRD1 genes were significantly different. These data suggest an association between the IVS2+31G>A SNP of the OPRM1 gene and pressure pain sensitivity in healthy adult females.
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Comparative Study
The effect of pneumoperitoneum and Trendelenburg position on acute cerebral blood flow-carbon dioxide reactivity under sevoflurane anaesthesia.
This study compared cerebral blood flow-carbon dioxide (CBF-CO2) reactivities in the supine and modest Trendelenburg position under pnemoperitoneum during sevoflurane anaesthesia. After induction of anaesthesia in 25 patients, mechanical ventilation was adjusted to increase Paco2 from 4.7 (T1) to 6.0 kPa (T2) in the supine position, and the change in jugular bulb oxygen saturation was measured as an index of CBF. ⋯ The CBF-CO2 reactivity was 7.5 (3.3) %xkPa(-1) (% change in jugular bulb oxygen saturation per unit change in Paco2) in the supine position and 6.8 (2.3) %xkPa(-1) in the 30 degrees Trendelenburg-pneumoperitoneum condition (p = 0.086). We conclude that CBF-CO2 reactivity is unchanged by the modest Trendelenburg position under pneumoperitoneum during sevoflurane anaesthesia.
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Case Reports
High frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway.
A 72 year-old man with an anticipated difficult airway secondary to a large, obstructing supraglottic tumour was scheduled for a panendoscopy. An elective pre-induction transtracheal catheter was placed to allow oxygenation if airway maintenance proved difficult. ⋯ The catheter was removed and high frequency jet ventilation was then used via the laryngeal mask airway to maintain oxygenation. To our knowledge, the use of high frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway has not been described before.
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This study aimed to determine whether bispectral index (BIS) can be used as an indicator of sedation and recovery with intravenous midazolam. In Part A, 30 healthy patients undergoing third molar extraction under local anaesthesia were recruited. They were sedated with intravenous midazolam titrated to clinical endpoints. ⋯ Seventy percent of Part B patients required increments of midazolam during surgery, compared to 16.7% in Part A (p < 0.001). Total dose of midazolam given was lower in Part B (p = 0.025). BIS is not effective as a sole indicator of endpoint in sedation with intravenous midazolam.
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We retrospectively reviewed the anaesthetic charts of patients who had undergone bariatric surgery in our regional centre since the start of the service. We identified Cormack and Lehane grade of laryngoscopy, any difficulties associated with tracheal intubation, and the impact of age, gender and body mass index on laryngoscopy grade. The patients were anaesthetised in the in the 'beach chair' position prior to laryngoscopy. ⋯ There were two cases (1%) of difficulty in intubation. A bougie was used 16 times (8%). Logistic regression showed that age was a significant factor for increasing laryngoscopy grade (p = 0.0102) but that BMI was not (p = 0.6271).