British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Detection of awareness in surgical patients with EEG-based indices--bispectral index and patient state index.
Patient state index (PSI) and bispectral index (BIS) are values derived from the EEG, which can measure the hypnotic component of anaesthesia. We measured the ability of PSI and BIS to distinguish consciousness from unconsciousness during induction and emergence from anaesthesia and a period of awareness in surgical patients. ⋯ Despite significant differences between mean values at responsiveness and non-responsiveness for BIS and PSI, neither measure may be sufficient to detect awareness in an individual patient, reflected by a P(k) less than below 70%.
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Comparative Study
Comparison of Alaris AEP index and bispectral index during propofol-remifentanil anaesthesia.
The Alaris AEP monitor(TM) (Alaris, UK, version 1.4) is the first commercially available auditory evoked potential (AEP) monitor designed to estimate the depth of anaesthesia. It generates an "Alaris AEP index" (AAI), which is a dimensionless number scaled from 100 (awake) to 0. This study was designed to compare AAI and BIS(TM) (Aspect, USA, version XP) values at different levels of anaesthesia. ⋯ During propofol-remifentanil anaesthesia a decrease of the depth of anaesthesia as indicated by BIS monitoring is accompanied by corresponding effects shown by the AAI. However, wide variation in the awake values and considerable overlap of AAI values between consciousness and unconsciousness, suggests further improvement of the AAI system is required.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of remifentanil and alfentanil during anaesthesia for patients undergoing direct laryngoscopy without intubation.
Remifentanil and alfentanil are opioids often used during direct laryngoscopy (DL). This prospective, randomized study compared these agents with respect to haemodynamic and Bispectral Index (BIS) responses, glottic visualization, and rapidity of recovery (spontaneous ventilation, eye opening) in DL without intubation. ⋯ This study showed that only remifentanil prevented MAP increase without adverse effects such as bradycardia during DL, and prevented MAP decrease 30 min after PACU admission.
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This review focuses on the development, current techniques, and clinical use of continuous intravascular blood gas monitoring (CIBM) devices in anaesthesia and intensive care. The operating principles, range of application, performance, limitations, costs, and impact on patient treatment and outcome, are discussed. Studies of early and currently available CIBM devices were analysed. ⋯ Performance in the clinical setting was not as satisfactory, especially for PO(2) values. However, the performance and accuracy of CIBM devices appear to be sufficient for clinical use and they are being used clinically in selected patient groups. Several factors affecting the performance of CIBM are considered.
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Multicenter Study
Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia.
Expert professional practice in any field is known to rely on both explicit (formal) and tacit (personal) forms of knowledge. Current anaesthetic training programmes appear to favour explicit knowledge and measurable competencies. We aimed to describe and explore the way different types of knowledge are learned and used in anaesthetic practice. ⋯ Opportunities for developing expertise are linked to the independent development of personal routines. Evidence-based approaches to professional practice may obscure the role played by the interpretation of knowledge. We suggest that the restriction of apprenticeship-style training threatens the acquisition of anaesthetic expertise as defined in this paper.