British journal of anaesthesia
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Impact of age on both BIS values and EEG bispectrum during anaesthesia with sevoflurane in children.
The aim of this study was to evaluate the potential relationship between age, BIS (Aspect), and the EEG bispectrum during anaesthesia with sevoflurane. ⋯ The EEG bispectrum, as well as the BIS appeared to be strongly related to the age of children at 1 MAC sevoflurane.
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Randomized Controlled Trial Clinical Trial
Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results.
We evaluated the sedative, haemodynamic and respiratory effects of dexmedetomidine and compared them with those of midazolam in children undergoing magnetic resonance imaging (MRI) procedures. ⋯ Dexmedetomidine provided adequate sedation in most of the children aged 1-7 yr without haemodynamic or respiratory effects during MRI procedures.
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This review examines the basic concepts of workload and methods of measuring them. The components of anaesthetists' operating room activities, and the factors contributing to workload, are analysed using an ergonomic-based model for technological environments. The available evidence on the relationship between workload and training and supervision is presented and the effect of workload on the quality and safety of anaesthetic care is reviewed. ⋯ The effects of production pressure and mental 'overload' remain speculative and so practical recommendations for anaesthetic staffing, both in terms of numbers and matching skills to surgical demand, cannot be made. The potential for delegation of tasks, for instance to non-physician anaesthetists, can also not be made on evidence-based grounds. Strategies for active management of workload may be useful in practice.
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Lower thoracic epidural anaesthesia and analgesia (EDA) has gained increasing importance in perioperative pain therapy. The loss-of-resistance technique used to identify the epidural space is thought to rely on the penetration of the ligamentum flavum. Investigations at the cervical and lumbar regions have demonstrated that the ligamentum flavum frequently exhibits incomplete fusion at different vertebral levels. Therefore, the aim of this study was to directly investigate the incidence of lower thoracic ligamentum flavum midline gaps in embalmed cadavers. ⋯ In the present study we have determined the frequency of lower thoracic ligamentum flavum midline gaps. Gaps are less frequent than at cervical levels, but more frequent than at lumbar levels. Peak incidence was found in the region between T10 and T12. Using a strict midline approach, one cannot therefore rely on the ligamentum flavum to impede entering the epidural space in all patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the respiratory effects of intravenous buprenorphine and fentanyl in humans and rats.
There is evidence from animal studies suggesting the existence of a ceiling effect for buprenorphine-induced respiratory depression. To study whether an apparent ceiling effect exists for respiratory depression induced by buprenorphine, we compared the respiratory effects of buprenorphine and fentanyl in humans and rats. ⋯ Our data confirm a ceiling effect of buprenorphine but not fentanyl with respect to respiratory depression.