British journal of anaesthesia
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Defluorination of sevoflurane is catalysed by the hepatic enzyme cytochrome P450 2E1 (CYP2E1). Data about the ontogenesis (developmental variations in activity) of this enzyme suggest a low metabolism of sevoflurane during the first months of life. ⋯ These results suggest that, in children less than 48 months, sevoflurane metabolism parallels postnatal development of CYP2E1.
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Several attempts have been made to evaluate patients' concerns with respect to postoperative recovery. To identify aspects of postoperative recovery relevant to patients, several methodological and statistical approaches have been used. One of the first to provide useful information was Fredrick Orkin who used conjoint analysis. This methodology is usually performed by market researchers to learn about the relative importance of product attributes. We used conjoint analysis in the present study. ⋯ Avoidance of PONV is a major concern for patients before surgery.
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A variety of techniques and drugs, many unlicensed, is used in paediatric regional anaesthesia. This study is the first to survey paediatric anaesthetists about the techniques and drugs used in paediatric regional anaesthesia. The aim is to provide a record and benchmark of UK practice. ⋯ Caudal anaesthesia is widely used for patients of all ages by almost all practitioners. Most anaesthetists at all hospital types and experience levels use adjuvants with local anaesthetics when performing caudal anaesthesia. Those with more experience in paediatric anaesthesia and those in specialist centres commonly use other neuraxial and peripheral block techniques.
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There is little advice on the posture to be used when intubating the trachea. Does the stance used depend on experience? ⋯ Novice anaesthetists should be given explicit instructions on correct trolley height and should be taught to intubate with a straight back.