British journal of anaesthesia
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Performance assessment is becoming increasingly necessary in the medical workplace. Hospitals and patients expect safety, and under-performance by a doctor can compromise standards. By describing and quantifying performance, positive behaviour can be encouraged and unsafe behaviour remedied. Anaesthesia Non-Technical Skills (ANTS) is a behavioural marker system that can be used to assess non-technical skills in the workplace. ⋯ Anaesthetists could not be trained to reliably use ANTS as a summative assessment tool using our 1 day programme. There was an inadequate correlation of scores between participants and experts. Two major problems contributed to the lack of agreement. Observed behaviours were often misclassified into the incorrect element and safety beliefs varied among anaesthetists. Other reasons for the failure to achieve success and potential future direction are discussed.
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In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy. ⋯ The benefit of adding ketamine to morphine in i.v. PCA for orthopaedic or abdominal surgery remains unclear. Owing to huge heterogeneity of studies and small sample sizes, larger double-blinded randomized studies showing greater degree of homogeneity are required to confirm these findings.
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Healthy vascular endothelium is coated by the glycocalyx, important in multiple endothelial functions, but destroyed by ischaemia-reperfusion. The impact of volatile anaesthetics on this fragile structure has not been investigated. We evaluated the effect of cardiac pre- and post-conditioning with sevoflurane on integrity of the endothelial glycocalyx in conjunction with coronary vascular function. ⋯ Sevoflurane protects the endothelial glycocalyx from ischaemia-reperfusion-induced degradation, with both preconditioning and rapid post-conditioning being successful. The mechanism seems to involve attenuation of lysosomal cathepsin B release and to be independent from tissue mast cell degranulation.
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Randomized Controlled Trial Comparative Study
Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: Performance of three pharmacokinetic-dynamic models.
In the ideal pharmacokinetic-dynamic (PK-PD) model for calculating the predicted effect-site concentration of propofol (Ce(PROP)), for any Ce(PROP), the corresponding hypnotic effect should be constant. We compared three PK-PD models (Marsh PK with Shüttler PD, Schnider PK with fixed ke0, and Schnider PK with Minto PD) in their ability to maintain a constant bispectral index (BIS), while using the respective effect-site-controlled target-controlled infusion (TCI) algorithms. ⋯ Targeting Ce(PROP) at which patients lose consciousness with effect-site-controlled TCI does not translate into an immediate constant effect.
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Controlled Clinical Trial
Effect of body mass index on the ED50 volume of bupivacaine 0.5% for supraclavicular brachial plexus block.
The aim of this study was to determine whether the ED(50) dose of bupivacaine 0.5% for supraclavicular brachial plexus block increases with increasing body mass index (BMI). ⋯ Our study demonstrates that the ED(50) of bupivacaine 0.5% does not increase with an increase in BMI. We found evidence of a possible inverse relationship between ED(50) and BMI.