Anaesthesia
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Randomized Controlled Trial Comparative Study
The effects of general anaesthesia on memory in children: a comparison between propofol and sevoflurane.
We studied the effects of general anaesthesia on memory 7 days and 3 months following elective hernia surgery. Sixty children aged between 7 and 13 years were randomly allocated to receive either propofol or sevoflurane. ⋯ Neither general anaesthetic affected immediate or long-term memory. We conclude that propofol impairs short-term memory postoperatively in children.
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Because of a lack of contemporary data regarding seizures after cardiac surgery, we undertook a retrospective analysis of prospectively collected data from 11 529 patients in whom cardiopulmonary bypass was used from January 2004 to December 2010. A convulsive seizure was defined as a transient episode of disturbed brain function characterised by abnormal involuntary motor movements. Multivariate regression analysis was performed to identify independent predictors of postoperative seizures. ⋯ Mean (IQR [range]) length of stay in the intensive care unit was 115 (49-228 [32-481]) h in patients with convulsive seizures compared with 26 (22-69 [14-1080]) h in patients without seizures (p < 0.001). Convulsive seizures are a serious postoperative complication after cardiac surgery. As tranexamic acid is the only modifiable factor, its administration, particularly in doses exceeding 80 mg.kg(-1), should be weighed against the risk of postoperative seizures.
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Case Reports
Awake intubation and awake prone positioning of a morbidly obese patient for lumbar spine surgery.
We describe the awake fibreoptic intubation followed by awake prone positioning of a woman weighing 180 kg with body mass index of 62 kg.m(-2) requiring emergency lumbar discectomy for cauda equina syndrome. This approach was taken to overcome difficulties in transfering an anaesthetised patient on to the operating table. ⋯ This technique optimised protection of the patient's eyes and other pressure areas while preventing undue cardiorespiratory compromise. The patient tolerated the procedure well, and later confirmed that she would consent to undergoing the same procedure again if further surgery became necessary.