British journal of anaesthesia
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This review discusses sedation for regional anaesthesia in the adult population. The first section deals with general aspects of sedation and shows that the majority of patients receiving sedation for regional anaesthesia are satisfied and would choose it again. ⋯ The techniques for administering sedation are discussed and replacement of the traditional repeated boluses or continuous infusion with pharmacokinetic and patient-controlled systems is supported. Patient satisfaction studies suggest that patient-controlled systems are preferred.
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Randomized Controlled Trial
Upper cervical spine movement during intubation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macintosh laryngoscope.
The AirWay Scope (AWS) is a new fibreoptic intubation device, which allows visualization of the glottic structures without alignment of the oral, pharyngeal, and tracheal axes, and thus may be useful in patients with limited cervical spine (C-spine) movement. We fluoroscopically evaluated upper C-spine movement during intubation with the AWS or Macintosh or McCoy laryngoscope. ⋯ Compared with the Macintosh or McCoy laryngoscope, the AWS produced less movement of upper C-spine for intubation in patients with a normal C-spine.
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The relationship between measures of drug effect such as bispectral index (BIS) and end-tidal (ET) levels of anaesthetic agents is described by the 'effect site equilibrium half-time', t(1/2)(ke0). There are limited data available on sevoflurane t(1/2)(ke0) during routine anaesthesia and surgery. Preliminary observations suggested t(1/2)(ke0) for the degree of hypnosis as estimated by BIS is different from that for burst suppression of the electroencephalograph, occurring at 'deep' levels of anaesthesia. This study aimed to determine and compare t(1/2)(ke0) for these two 'effects'. ⋯ The different values of t(1/2)(ke0) for these effects suggest different sites or mechanisms of action. These results also establish values of t(1/2)(ke0) which can be used to provide the real-time estimates of effect-site sevoflurane concentration in clinical practice.
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Large quantities of water condensation occur in the anaesthesia circuit during low-flow anaesthesia. We hypothesized that cooling of the CO2 absorbent would prevent water condensation. ⋯ TGR of CO2 absorbent with cooling is a useful and simple method to reduce water condensation in the anaesthesia circuit in low-flow anaesthesia, with a little increase in the longevity of the CO2 absorbent.
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In this prospective observational study, we aim to explore the relationship between age and bispectral index (BIS) values at different plasma concentrations of propofol. ⋯ These results showed the difficulty to interpret BIS values because of the absence of significant change for higher plasma propofol concentration variation or because of the link with age for the lower plasma concentration.