British journal of anaesthesia
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Multicenter Study
Relationship between perioperative troponin elevation and other indicators of myocardial injury in vascular surgery patients.
In 2000 the European Society of Cardiology and the American College of Cardiology published a consensus document revising the definition of myocardial infarction. The usefulness of this revised definition has been challenged. It has been suggested that, rather than any release of cardiac troponin being potentially diagnostic of myocardial infarction, a diagnostic threshold consistent with significant myocardial injury should be defined. ⋯ These data suggest that further studies are required to define the optimal cardiac troponin diagnostic threshold for the diagnosis of myocardial infarction in the non-cardiac surgery population.
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A computer controlled infusion device for S(+) ketamine was used in combination with a Diprifusor device to provide anaesthesia for 20 ASA I or II patients undergoing elective colonoscopy. The aim of the study was to assess the performance of the pharmacokinetic model for S(+) ketamine used in the delivery algorithm of the device. ⋯ It was necessary to modify the original published pharmacokinetic parameters incorporated into the S(+) ketamine delivery system in order to simulate improved PK performance during short procedures (<1 h duration) where propofol was concurrently administered. This improved performance was confirmed in a further prospective study.
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We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.
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During general anaesthesia in the presence of neuromuscular blocking drugs clinical criteria cannot detect the presence of consciousness. Various 'depth of anaesthesia' monitors are available which claim to prevent consciousness and/or reduce anaesthetic drug use. This study uses the Narcotrend anaesthesia brain monitor to guide anaesthetic administration but at the same time checks for the presence of intra-operative consciousness by using the 'isolated forearm' technique throughout the whole surgical/anaesthetic procedure. ⋯ The Narcotrend was unable to differentiate reliably between conscious and unconscious patients during general anaesthesia when neuromuscular blocking agents were used.