British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index.
We compared two spectral entropies, state entropy (SE) and response entropy (RE), based on the irregularity of the EEG, to measure loss of response to verbal command (LOR(verbal)) and noxious stimulus (LOR(noxious)) with the bispectral index (BIS) during propofol infusion with and without remifentanil. ⋯ LOR(verbal) was detected accurately by BIS, SE and RE except for 100% sensitivity, where BIS performed better. Though BIS, SE and RE were influenced by remifentanil during propofol administration, their ability to detect LOR(verbal) remained accurate. None of the measures predicted LOR(noxious).
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Randomized Controlled Trial Clinical Trial
Small dose of clonidine mixed with low-dose ropivacaine and fentanyl for epidural analgesia after total knee arthroplasty.
We studied whether a small dose of clonidine added to a ropivacaine-fentanyl mixture improves epidural analgesia without provoking side effects typically related to larger amounts of epidural clonidine. ⋯ The small amount of clonidine added to the low-dose ropivacaine-fentanyl mixture reduced the need for opioid rescue pain medication after TKA. Clonidine slightly decreased arterial pressure and heart rate without jeopardizing haemodynamics. Otherwise, the side effect profiles were comparable in both groups.
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Randomized Controlled Trial Clinical Trial
Target concentrations of remifentanil with propofol to blunt coughing during intubation, cuff inflation, and tracheal suctioning.
The target blood concentrations of propofol and remifentanil, when used in combination, required to blunt the cough response to tracheal intubation, cuff inflation, and tracheal suctioning without neuromuscular blocking agents are not known. ⋯ Target remifentanil blood concentrations of 5, 10, and 15 ng ml(-1) associated with a 3.5 microg ml(-1) propofol target blood concentration provided good intubating conditions and absence of cough about 75% of the time. Higher target remifentanil concentrations were associated with less coughing during tracheal tube cuff inflation and tracheal suctioning.
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Jugular bulb oxygen saturation (Sjv(o(2))) is a surrogate marker for global cerebral oxygenation. The effect of milrinone on Sjv(o(2)) and the cerebrovascular carbon dioxide reactivity (CCO2R) was investigated. ⋯ Although milrinone induced significant haemodynamic changes, Sjv(o(2)) and CCO(2)R were unchanged during its administration.
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Hermansky-Pudlak syndrome is a multisystem disorder with albinism, bleeding diathesis and visual impairment as the main features. We report a case of epidural analgesia in a pregnant patient, who was subsequently discovered to have this syndrome. We believe this to be the first such report.