British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Psychomotor recovery in very old patients after total intravenous or balanced anaesthesia for cataract surgery.
We compared psychomotor recovery after total intravenous anaesthesia (TIVA) with remifentanil/propofol and balanced anaesthesia (BAL) with etomidate/fentanyl/isoflurane in 40 patients, ASA I-III, aged > or =80 yr undergoing elective cataract surgery. Recovery times were recorded and psychomotor recovery was assessed according to simple reaction time, critical flicker fusion frequency (CFF) and short-term memory 30 min, 2 h and 1 day after surgery. Physical characteristics of patients in the two groups (19 in the TIVA group and 21 in the BAL group) were comparable. ⋯ Only performance in the CFF test remained below baseline at this point. No deficits in psychomotor performance were noted on the first day after surgery. We conclude that there is only a minor deficit in psychomotor function in elderly patients 2 h after cataract surgery under general anaesthesia and that psychomotor function recovers completely by 24 h after surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Attenuation of haemodynamic responses to tracheal intubation by the styletscope.
Tracheal intubation often causes a haemodynamic response probably generated by direct laryngoscopy. The StyletScope is a new intubation device that does not require direct laryngoscopy. We prospectively measured haemodynamic changes after tracheal intubation using the StyletScope. The increase of heart rate was less during tracheal intubation with the StyletScope when compared with the Macintosh laryngoscope.
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Randomized Controlled Trial Clinical Trial
Absence of memory for intra-operative information during surgery with total intravenous anaesthesia.
While using the isolated forearm technique, we wished to determine whether patients who did not respond to commands during general anaesthesia with a total intravenous technique (propofol and alfentanil with atracurium) had any evidence of post-operative explicit or implicit memory. Forty women undergoing major gynaecological surgery were randomized, in a double-blind design, to hear two different tapes during surgery. ⋯ We conclude that during total intravenous anaesthesia with propofol and alfentanil, there is no evidence that learning takes place when anaesthesia is adequate. Furthermore, with this anaesthetic technique, it would seem that--provided any period of patient responsiveness is short and that unconsciousness is induced rapidly again--there is no evidence of implicit or explicit memory.
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Practice Guideline Guideline
Guidelines for molecular genetic detection of susceptibility to malignant hyperthermia.
Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disease triggered by several anaesthetic agents. The in vitro muscle contracture test (IVCT) is the standard test to establish an individual's risk of susceptibility to MH. Clinical practitioners and geneticists of the European MH Group have agreed on the present guidelines for the detection of MH susceptibility using molecular genetic techniques and/or IVCT to predict the risk of MH.
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Comparative Study
EEG bispectral index and hypnotic component of anaesthesia induced by sevoflurane: comparison between children and adults.
This prospective study was designed to evaluate the correlation between the electroencephalographic bispectral index (BIS) and the hypnotic component of anaesthesia (CA) induced by sevoflurane in 27 children and 27 adult patients. BIS and CA were compared at loss of consciousness (LOC) and on recovery of consciousness (ROC). Mean (SD) BIS decreased significantly at LOC in children and adults from 94 (2.7) to 87.4 (4) and from 96.2 (2) to 86.7 (4.4), respectively, without any difference between groups. ⋯ Correlation coefficients between BIS and CA in ROC were -0.876 in children and -0.837 in adults. BIS values at ROC were not different from those at LOC in either group. These data demonstrate that BIS correlates with the hypnotic component of anaesthesia induced by sevoflurane in children as well as in adults.