Anaesthesia
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A brief review of post-operative delirium and post-operative cognitive decline, the possibility that anaesthesia and surgery may contribute (though for which evidence is observational and low quality), and potential methods for detection, quantification and avoidance.
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Randomized Controlled Trial Multicenter Study
The analgesic efficiency of combined pregabalin and ketamine for total hip arthroplasty: a randomised, double-blind, controlled study.
Pregabalin and ketamine given together have a small, additive effect in reducing post-operative pain after total hip arthroplasty.
pearl -
Randomized Controlled Trial
Therapeutic effect of inhaled budesonide (Pulmicort(®) Turbuhaler) on the inflammatory response to one-lung ventilation.
Pre-operative nebulised budenoside may improve ventilation pressures and compliance, and reduce the inflammatory response to one-lung ventilation.
pearl -
Randomized Controlled Trial
Closed-loop double-vasopressor automated system vs manual bolus vasopressor to treat hypotension during spinal anaesthesia for caesarean section: a randomised controlled trial.
Hypotension necessitating vasopressor administration occurs commonly during caesarean section under spinal anaesthesia. We developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non-invasive arterial pressure monitoring. A phenylephrine bolus of 50 μg was given at 30-s intervals when systolic blood pressure fell < 90% of baseline; an ephedrine bolus of 4 mg was given instead if systolic pressure fell < 90% of baseline together with a heart rate < 60 beats.min(-1). ⋯ The automated vasopressor group had lower median absolute performance error of 8.5% vs control of 9.8% (p = 0.013), and reduced incidence of nausea (1/106 (0.9%) vs 11/107 (10.3%), p = 0.005). Neonatal umbilical cord pH, umbilical lactate and Apgar scores were similar. Hence, our system afforded better control of maternal blood pressure and reduced nausea with no increase in reactive hypertension when compared with manual boluses.
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A number of recent reports have highlighted the inadequate provision of pain relief for older inpatients. Despite the availability of numerous validated pain measures, pain remains poorly assessed in some cases and, particularly, in the cognitively impaired. ⋯ Most drugs and techniques that are used for analgesia in younger patients are also suitable for older patients, although dosages may have to be adjusted to avoid the side-effects that are consequent upon age-related changes in drug pharmacokinetics and pharmacodynamics, co-morbidity, frailty, cognitive impairment and polypharmacy. This paper reviews current guidelines and methods of assessing pain in the older adult, and describes the use of, and problems with, mild, moderate, strong, adjuvant and local anaesthetic drugs in the older population for analgesia, advocating multimodal intervention to reduce dose-related side-effects, particularly of opioids.