British journal of anaesthesia
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Peripheral nerve blocks are almost always performed as blind procedures. The purpose of this study was to test the feasibility of seeing individual nerves of the brachial plexus and directing the block needle to these nerves with real time imaging. ⋯ The use of ultrasound appears to permit accurate deposition of the local anaesthetic perineurally, and has the potential to improve the success and decrease the complications of infraclavicular brachial plexus block.
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The bispectral index (BIS) and the rapidly extracted auditory evoked potentials index (A-line ARX Index or AAI) have been proposed as methods to measure the depth of sedation. A prospective study was designed to assess the performance of both these methods for measuring the depth of sedation induced by propofol or midazolam under epidural block. ⋯ Both AAI and BIS correlated well with the depth of sedation induced by propofol or midazolam under epidural block. AAI may be more valuable when monitoring depth of sedation.
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Randomized Controlled Trial Clinical Trial
Plasma concentration of ropivacaine after intercostal blocks for video-assisted thoracic surgery.
Absorption of local anaesthetics following intercostal blocks is rapid. Therefore, plasma concentrations of ropivacaine during intercostal blocks with ropivacaine 2, 5, 7.5 and 10 mg ml-1 (ropivacaine 5 ml injected into each of four intercostal spaces) in patients undergoing video-assisted thoracic surgery were determined. ⋯ After intercostal blocks the absorption of ropivacaine is rapid compared with other techniques for regional anaesthesia and results in relatively high venous and arterial plasma concentrations, especially if a dose of 100 mg or more is used.
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We have developed a prediction rule for the occurrence of perioperative red blood cell transfusion to help to reduce the number of unnecessary preoperative type and screen procedures. We evaluated the robustness of this prediction rule in patients from another hospital. ⋯ After comparing the results of this validation study with that of the derivation study, the prediction rule was robust and may work in other clinics as well.
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In clinical use, midazolam reduces the dose requirement for propofol. We studied the effect of midazolam given before anaesthesia on the amount of propofol needed and the time taken, to achieve loss of consciousness (LOC) in 20 patients. ⋯ We confirmed that coinduction of anaesthesia with midazolam and propofol reduces the requirement of propofol. We also demonstrated that the AER reflects anaesthetic depth rather than plasma concentrations of anaesthetic drugs.