British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Is the clinical efficacy of epidural diamorphine concentration-dependent when used as analgesia for labour?
The physicochemical properties of diamorphine (3,6-diacetylmorphine) enhance its bioavailability compared with more lipid-soluble opioids when administered into the epidural space. However, the influence of concentration, volume or mass on the clinical efficacy of diamorphine is not known. ⋯ We conclude that diamorphine provides analgesia in labour by a concentration-dependent effect.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anaesthesia as guided by bispectral index.
The aim of this study was to determine if propofol caused less suppression of cortical somatosensory evoked potentials (SSEPs) during spine surgery compared with isoflurane during comparable depth of anaesthesia as guided by bispectral index (BIS) measurements. ⋯ Propofol anaesthesia caused less suppression of the cortical SSEP, with better preservation of SSEP amplitude, and less variability at an equivalent depth of anaesthesia.
-
Randomized Controlled Trial Clinical Trial
Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children.
Ilioinguinal and iliohypogastric (IG-IH) nerve block has been widely used in children undergoing inguinal hernia repair. This technique may provide insufficient analgesia for intraoperative management as the inguinal region may receive sensory innervation from genitofemoral nerve. We proposed that addition of a genitofemoral nerve block might improve the quality of analgesia. ⋯ The benefit of the additional genitofemoral nerve block to IG-IH nerve block was limited only to the time of sac traction without any postoperative effect. This suggests there is little clinical benefit in the addition of a genitofemoral nerve block.
-
We measured middle cerebral artery (MCA) flow velocity (FV), dynamic pressure autoregulation, and carbon dioxide reactivity (CRCO(2)) in patients with chronic renal failure before and after haemodialysis using transcranial Doppler ultrasonography. ⋯ MCA FV decreases significantly after haemodialysis. Dynamic pressure autoregulation and CRCO(2) remain normal in patients with chronic renal failure, and are not altered significantly by haemodialysis.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Preconditioning with sevoflurane decreases PECAM-1 expression and improves one-year cardiovascular outcome in coronary artery bypass graft surgery.
Cardiac preconditioning is thought to be involved in the observed decreased coronary artery reocclusion rate in patients with angina preceding myocardial infarction. We prospectively examined whether preconditioning by sevoflurane would decrease late cardiac events in patients undergoing coronary artery bypass graft (CABG) surgery. ⋯ This prospective randomized clinical study provides evidence of a protective role for pharmacological preconditioning by sevoflurane in late cardiac events in CABG patients, which may be related to favourable transcriptional changes in pro- and antiprotective proteins.