British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study
Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study.
Bladder discomfort related to intraoperative catheterization of urinary bladder is a distressing symptom and more so in patients awakening from anaesthesia. These symptoms are similar to symptoms of overactive bladder. Muscarinic receptor antagonists have been reported to be effective in the treatment of overactive bladder. This study was therefore undertaken to evaluate the efficacy of oxybutynin and tolterodine in preventing catheter related bladder discomfort. ⋯ Pretreatment with either oxybutynin or tolterodine reduces the incidence and severity of catheter related bladder discomfort.
-
Randomized Controlled Trial
Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation.
Hypnotic depth but not haemodynamic response to painful stimulation can be measured with various EEG-based anaesthesia monitors. We evaluated the variation of pulse plethysmography amplitude induced by an electrical tetanic stimulus (PPG variation) as a potential measure for analgesia and predictor of haemodynamic responsiveness during general anaesthesia. ⋯ Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.
-
Randomized Controlled Trial
Combined use of Bispectral Index and A-Line Autoregressive Index to assess anti-nociceptive component of balanced anaesthesia during lumbar arthrodesis.
This study evaluated the A-Line Autoregressive Index (AAI) response to surgical stimulation during lumbar arthrodesis, as an estimate of the anti-nociceptive component of a Bispectral Index (BIS) guided anaesthesia combined with epidural analgesia. ⋯ During a BIS-guided constant level of hypnosis, AAI response to the onset of surgical stimulation significantly differs according to the analgesic regimen. Further studies are needed to refine the estimation of sensitivity and specificity of this variable in assessing the balance between nociception and anti-nociception during general anaesthesia.
-
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.
-
Until recently epidural abscess was considered a rare, almost theoretical, complication of central nerve block, but anecdotal reports suggest that this is no longer the case. Thus a review of the risk factors, pathogenesis, clinical features and outcome of this condition is appropriate, the primary aim being to make recommendations on best anaesthetic practice to minimize the risk of this serious complication. A search of EMBASE(c), PUBMED(c) and MEDLINE(c) databases from 1966 to September 2004 was performed using several strategies, supplemented by reference list screening. ⋯ Epidural abscess can be a catastrophic consequence of central nerve block. Early diagnosis will minimize permanent damage, but primary prevention should be the aim. There is a need for a large survey to indicate the true incidence to better inform the risk-benefit ratio for central nerve block.