British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Entropy indices vs the bispectral index for estimating nociception during sevoflurane anaesthesia.
It is now possible to acquire and process raw EEG and frontal EMG signals to produce two spectral-entropy-based indices (response entropy and state entropy) reflective of analgesic and hypnotic levels during general anaesthesia (with the Datex-Ohmeda S/5 Entropy Module, Datex-Ohmeda, Helsinki, Finland). However, there are no data available on the accuracy of the Entropy Module in estimating nociception during sevoflurane anaesthesia. ⋯ Noxious stimulation increased the difference between response entropy and state entropy. However, an increase in the difference does not always indicate inadequate analgesia and should be interpreted carefully during anaesthesia.
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In view of the wide variation in pain experience between patients, a clinical standard -- the time from the end of surgery to the first experience of pain -- was applied to 1359 consecutive patients in order to investigate whether the initial quality of epidural block has an effect on the overall quality of postoperative pain relief. ⋯ Extending pain relief for more than 12 h beyond the end of abdominal surgery significantly improves the overall quality of postoperative pain relief, but is associated with an increase in side-effects.
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Estimation of analgesia in anaesthetized children is often imprecise, and consequently, anaesthesiologists commonly evaluate children's response to surgical stimulation by movement or haemodynamic changes. In adults reflex pupillary dilatation has been demonstrated to be a very sensitive measure of noxious stimulation, correlated with opioid concentrations. The autonomic nervous control changes with age, raising the hypothesis that mechanisms involved in pupillary autonomic functions regarding both sympathetic and parasympathetic components may also differ between adults and children. In this pilot study, we tested the hypothesis that the pupillary reflex dilatation might allow assessment of noxious stimulation and analgesic effect of alfentanil in children under sevoflurane anaesthesia, as an alternative to haemodynamic and bispectral measures. ⋯ PD is a more sensitive measure of noxious stimulation than the commonly used variables of heart rate, arterial blood pressure and BIS in children anaesthetized with sevoflurane.
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Little information exists regarding factors influencing perioperative cardiac arrests and their outcome. This survey evaluated the incidence, causes and outcome of perioperative cardiac arrests in a Brazilian tertiary general teaching hospital between April 1996 and March 2005. ⋯ Perioperative cardiac arrests were relatively higher in neonates, infants, the elderly and in males with severe underlying disease and under emergency surgery. All anaesthesia-related cardiac arrests were related to airway management and medication administration which is important for prevention strategies.
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Randomized Controlled Trial
Ketamine for treatment of catheter related bladder discomfort: a prospective, randomized, placebo controlled and double blind study.
Intraoperative urinary catheterization might cause postoperative catheter related bladder discomfort (CRBD). We evaluated the efficacy of ketamine as a treatment modality for CRBD. ⋯ I.V. ketamine (250 microg kg(-1)) is an effective treatment for reducing the incidence and severity of postoperative CRBD.