British journal of anaesthesia
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Review Meta Analysis
Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression.
Various techniques and drug regimes for thoracic paravertebral block (PVB) have been evaluated for post-thoracotomy analgesia, but there is no consensus on which technique or drug regime is best. We have systematically reviewed the efficacy and safety of different techniques for PVB. Our primary aim was to determine whether local anaesthetic (LA) dose influences the quality of analgesia from PVB. ⋯ Continuous infusions of LA predicted lower pain scores compared with intermittent boluses (P=0.04 at 8 h, P=0.003 at 24 h, and P<0.001 at 48 h). The use of adjuvant clonidine or fentanyl, pre-emptive PVB, and the addition of patient-controlled opioids to PVB did not improve analgesia. Further well-designed trials of different PVB dosage and drug regimes are needed.
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Randomized Controlled Trial Comparative Study
Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.
The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial. ⋯ The AWS and the Glidescope laryngoscopes reduced the difficulty of tracheal intubation to a similar extent compared with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation.
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Randomized Controlled Trial
Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro.
Metastatic recurrence is the main cause of breast cancer-related deaths. Tumour cell proliferation and migration are crucial steps in the metastatic process. Several perioperative factors, including general anaesthesia and opioid analgesia, adversely affect immune function, potentially increasing metastatic recurrence. Regional anaesthesia-analgesia has been consistently shown to attenuate the stress response to surgery, and also reduce opioid and general anaesthesia requirements, thereby attenuating this perioperative immunosuppression. We investigated the effect of serum from breast cancer surgery patients who received different anaesthetic techniques on breast cancer cell function in vitro. ⋯ Serum from patients receiving propofol/paravertebral anaesthesia for breast cancer surgery inhibited proliferation, but not migration, of ER-MDA-MB-231 cells in vitro, to a greater extent than that from patients receiving sevoflurane/opioid anaesthesia-analgesia. This implies that anaesthetic technique alters the serum molecular milieu in ways that may affect breast cancer cell function, possibly by altering anaesthetic and opioid drug administration and resultant pain scores.
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Cognitive overload has been recognized as a significant cause of error in industries such as aviation, and measuring mental workload has become a key method of improving safety. The aim of this study was to pilot the use of a new method of measuring mental workload using a previously published study design. ⋯ These findings confirm the importance of mental workload to the performance of anaesthetists, and suggest that raised mental workload is likely to be a common problem. Although further studies are required, the method described may provide a useful method for the measurement of the mental workload of anaesthetists.
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Comparative Study
Functional comparison of anaesthetic agents during myocardial ischaemia-reperfusion using pressure-volume loops.
Left ventricular (LV) pressure-volume (PV) loops were used to compare the functional effects that accompany the cardioprotection seen with desflurane, sevoflurane, and propofol in a rabbit preparation of coronary ischaemia-reperfusion (IR). ⋯ During ischaemia, all anaesthetics provide haemodynamic stability and preservation of LV contractility, whereas propofol and sevoflurane, but not desflurane, caused increased LV diastolic stiffness. Desflurane and sevoflurane provide superior cardioprotection compared with propofol.