British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring.
Sevoflurane or propofol-remifentanil-based anaesthetic regimens represent modern techniques for neurosurgical anaesthesia. Nevertheless, there are potential differences related to their activity on the cerebrovascular system. The magnitude of such difference is not completely known. ⋯ Propofol-remifentanil anaesthesia induced a dose-dependent low-flow state with preserved cerebral autoregulation, whereas sevoflurane at high doses provided a certain degree of luxury perfusion.
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Randomized Controlled Trial
Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy.
This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children. ⋯ Caudal tramadol 2 mg kg(-1), combined with bupivacaine 0.25% 0.75 ml kg(-1), provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg(-1) or 1.5 mg kg(-1) in children undergoing inguinal herniotomy.
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Multicenter Study
Perioperative fluid therapy in children: a survey of current prescribing practice.
Fluid therapy in children may be associated with iatrogenic hyponatraemia. We surveyed anaesthetists' current fluid prescribing practice during the perioperative period, departmental fluid protocols and awareness of the concerns of the Royal College of Paediatrics and Child Health (RCPCH) about the use of dextrose 4%/saline 0.18% in children. ⋯ The prescription of hypotonic dextrose saline solutions by anaesthetists may be putting children at risk from iatrogenic hyponatraemia. Departmental protocols for perioperative fluid prescription in children are uncommon. We suggest that national guidance is required.
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Comparative Study
Cerebral state index: comparison between pairwise registrations from the left and the right sides of the brain.
Lateralization of cerebral blood flow and EEG activity is known to vary during cognition, sleep and waking. In spite of this, electrode placement for the cerebral state index (CSI) monitor is not specified to a particular side of the brain. This study is designed to determine if pairwise registrations differ for CSI measured simultaneously from the left or right sides of the brain. ⋯ Despite known lateralization of the EEC, this study found a very high correlation in CSI derived simultaneously from the left and right sides of the brain by two independent monitors.
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Published work on knowledge in regional anaesthesia has focused on competence, for instance by identifying numbers of procedures required to achieve competence, or by defining criteria for successful performance of blocks. We aimed to define expertise in regional anaesthesia and examine how it is acquired. ⋯ Expertise in regional anaesthesia extends beyond competence at technical performance; non-cognitive elements are also vital. Further work is needed to test our learning model, and the hypothesis that learning can be enhanced by deliberate promotion of the tacit elements of 'expertise' we have described.