British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Esmolol prevents movement and attenuates the BIS response to orotracheal intubation.
Beta-adrenergic agonists enhance behavioural and electroencephalographic arousal reactions. We explored whether adding esmolol, a short-acting beta(1)-adrenoceptor antagonist, to propofol anaesthesia modified the bispectral index (BIS) during induction of anaesthesia and orotracheal intubation. ⋯ Esmolol not only attenuated haemodynamic and somatic responses to laryngoscopy and orotracheal intubation, but also prevented BIS arousal reactions in patients anaesthetized with propofol.
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Multicenter Study
Patient satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria.
We describe the development and comparison of a psychometric questionnaire on patient satisfaction with anaesthesia care among six hospitals. ⋯ A psychometric questionnaire on patient satisfaction with anaesthesia care must cover areas such as patient information, involvement in decision-making, and contact with the anaesthetist. The assessment using summed scores for dimensions is more informative than a global summed rating. There were significant differences between hospitals. Moreover, the high problem scores indicate a great potential for improvement at all hospitals.
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Randomized Controlled Trial Clinical Trial
Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability.
Codeine analgesia is wholly or mostly due to its metabolism to morphine by the cytochrome P450 enzyme CYP2D6, which shows significant genetic variation in activity. The aims of this study were to investigate genotype, phenotype and morphine production from codeine in children undergoing adenotonsillectomy, and to compare analgesia from codeine or morphine combined with diclofenac. ⋯ Reduced ability for codeine metabolism may be more common than previously reported. Plasma morphine concentration 1 h after codeine is very low, and related to phenotype. Codeine analgesia is less reliable than morphine, but was not well correlated with either phenotype or plasma morphine in this study.
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Information on anaesthesia interventions, plans and risks is needed by patients and carers alike and is a key component of the Good Practice In Consent initiative. Existing information materials may under-represent what patients are able to contribute. ⋯ Working in parallel does not give our hospitals excellent, effective patient information materials. Demand exists for The Royal College of Anaesthetists to lead in this area. Working in partnership with patients and taking into account existing written guidance is important but has often been overlooked.
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Clinical Trial
Sevoflurane anaesthesia in children after induction of anaesthesia with midazolam and thiopental does not cause epileptiform EEG.
Sevoflurane is a methyl ether anaesthetic commonly used for induction and maintenance of general anaesthesia in children. Sevoflurane is a non-irritant and acts quickly so induction is usually calm. However, inhalation induction with high concentrations of sevoflurane can cause convulsion-like movements and seizure-like changes in the electroencephalogram (EEG). Little is known about the EEG during maintenance of anaesthesia with sevoflurane, so we planned a prospective trial of sevoflurane maintenance after i.v. induction with benzodiazepine and barbiturate, which is another common induction technique in children. ⋯ Premedication with midazolam, i.v. induction with thiopental and maintenance of anaesthesia with 2% sevoflurane in air does not cause epileptiform EEG patterns in children.