British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test.
Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery. ⋯ Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery.
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Randomized Controlled Trial
Effect of prophylactic bronchodilator treatment with i.v. carperitide on airway resistance and lung compliance after tracheal intubation.
Lung resistance increases after induction of anaesthesia. We hypothesized that prophylactic bronchodilation with i.v. carperitide before tracheal intubation would decrease airway resistance and increase lung compliance after placement of the tracheal tube in both smokers and nonsmokers. ⋯ Marked bronchoconstriction occurred in the control groups (smokers and nonsmokers) 4 min after tracheal intubation. Prophylactic treatment with carperitide before induction of anaesthesia and tracheal intubation was advantageous, particularly in smokers.
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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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We present a case of torsion dystonia in a 35-yr-old primigravida who presented for a Caesarean section under general anaesthesia. She had limb contractures and severe kyphoscoliosis associated with limited respiratory reserve and function. ⋯ Technical issues of supine positioning, intubation and respiratory support need to be considered during anaesthesia planning. Although regional anaesthesia is commonly offered for caesarean section, maternal compromise and technical factors may preclude this approach.
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In this prospective, clinical study we tested the hypothesis whether two different doses of spinal administered bupivacaine and accordingly, two different levels of spinal anaesthesia can affect the dose requirement of propofol during BIS guided sedation. ⋯ A high spinal block obtained with hyperbaric bupivacaine 17.5 mg was associated with a faster onset, delayed recovery and lower doses of propofol sedation compared with a low spinal block with 7.5 mg of the same drug.