Anaesthesia
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Adults who experience intra-operative awareness can develop disturbing long-lasting after-effects, such as daytime anxiety, sleep disturbances, nightmares, flashbacks and, in the worst case, a post-traumatic stress disorder (PTSD). It is unknown whether intra-operative awareness has a similar psychological impact in children. We designed the present study in order to evaluate the incidence of psychological symptoms in children who had either confirmed or possible intra-operative awareness. ⋯ In contrast with what has been reported in adults, these children claimed not to have experienced major pain, terror or helplessness during their surgery. Despite the small sample size, the results of the present study suggest that children suffer less psychological sequelae than adults following intra-operative awareness. This may be due to the fact that the children reported less frightening intra-operative sensations as compared with the adults, and had less understanding of the anaesthesia procedure, and this may have influenced their appraisal of their awareness and protected them from the full impact of this potentially traumatic experience.
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The National Patient Safety Agency (NPSA) identified practice improvements with regard to epidural injections and infusions and released a patient safety alert on 28th March 2007. Prior to this, the Obstetric Anaesthetists' Association had considered the draft document and wished to assess current compliance in UK obstetric units. ⋯ The response rate was 89%. Many units are already following the guidance from the NPSA but nearly one in four units have experience of wrong route drug errors related to confusion between systems for intravenous and regional drug administration.
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While many intensive care clinicians in the UK continue to express significant concerns regarding controlled non-heart beating organ donation, others are involved in established programmes that make an increasingly significant contribution to the total number of cadaveric donations each year. The successful introduction of a controlled non-heart beating organ donation programme requires local resolution of any apparent ethicolegal obstacles to the process, with specific attention needing to be given to three areas: the potential conflict of interest between decision making over futility and any subsequent approach regarding organ donation; a belief that it may be unlawful to adjust in any way an end of life care pathway in order to allow donation to take place, and, finally, an uncertainty over how soon after cardiac death organ retrieval can begin. It is proposed that recent changes in legislation provide, through an emphasis on patient autonomy and best interests, a solid ethicolegal foundation for donation after cardiac death.
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Randomized Controlled Trial
The effect of lidocaine on remifentanil-induced cough.
This study was performed to investigate the incidence of remifentanil-induced cough and evaluate the efficacy of lidocaine on its prevention. Five-hundred patients, aged 18-70 years, were randomly allocated into two groups to receive either lidocaine 0.5 mg x kg(-1) or 0.9% normal saline intravenously 1 min before remifentanil administration at a target effect-site concentration of 4 ng x ml(-1). ⋯ The results of logistic regression indicated that age and smoking were associated with remifentanil-induced cough. This study demonstrated that intravenously administered lidocaine 0.5 mg x kg(-1) effectively suppresses remifentanil-induced cough without possible systemic lidocaine toxicity.
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Randomized Controlled Trial
The influence of changes in end-tidal carbon dioxide upon the Bispectral Index.
Carbon dioxide is known to affect consciousness in animals and humans. We surmised that changes in end-tidal carbon dioxide during anaesthesia might affect the Bispectral Index. Twenty-four patients due to undergo surgery were anaesthetised with fentanyl and a propofol infusion. ⋯ The patients acted as their own controls as they were subjected to high, normal and low levels of end-tidal carbon dioxide (3-12 kPa) according to a randomised sequence. There were no changes in the Bispectral Index or haemodynamic variables resulting from manipulation of the end-tidal carbon dioxide. At the level of hypnosis involved in this study, changes in end-tidal carbon dioxide, within the range tested, do not result in changes in the Bispectral Index.