British journal of anaesthesia
-
Clinical Trial
Analgesia nociception index: evaluation as a new parameter for acute postoperative pain.
A means of identifying the presence and severity of pain that is not reliant on the subjective assessment of pain is desirable whenever a patient self-rating of pain cannot be easily obtained (e.g. sedated patients, very young children, individuals with learning difficulties). The heart rate variability based analgesia nociception index (ANI) has been proposed to reflect different levels of acute pain. The aim of this study was to compare ANI scores with a numeric rating scale (NRS, 0-10) based on self-assessment of pain in the recovery room. ⋯ ANI did not reflect different states of acute postoperative pain measured on a NRS scale after adult sevoflurane-based general anaesthesia.
-
Retrosternal goitre (RSG) is an uncommon problem encountered rarely by anaesthetists working outside specialized head and neck (H&N) surgical units. Traditional anaesthetic teaching warns of difficult airway management in these patients. The incidence and extent of these problems is unclear. ⋯ When managed within a dedicated H&N operating theatre we have found a low incidence of difficult tracheal intubation, difficult mechanical ventilation nor postoperative respiratory difficulties in patients with massive RSG and mid-tracheal compression because of benign multi-nodular goitre. Surgical complications, however, are more frequent than those associated with cervical thyroidectomy with RLN injury and postoperative bleeding more likely.
-
Curcumin, the active ingredient of turmeric (Curcuma longa), has a wide range of beneficial effects including anti-inflammation and analgesia. However, poor bioavailability of curcumin hinders its clinical application. To overcome this limitation, we modified the structure of curcumin and synthesized new derivatives with favourable pharmacokinetic profiles. Recently, curcumin has been shown to have an antagonizing effect on transient receptor potential vanilloid type 1 (TRPV1) ion channels. We investigated the antinociceptive activity of KMS4034 which had the most favourable pharmacokinetics among the tested curcumin derivatives. ⋯ KMS4034 may be an effective analgesic for various pain conditions.
-
This systematic review and meta-analysis summarizes the clinical effects of increasing perioperative blood flow using fluids with or without inotropes/vasoactive drugs to explicit defined goals in adults. We included randomized controlled trials of adult patients (aged 16 years or older) undergoing surgery. We included 31 studies of 5292 participants. ⋯ Patients receiving this intervention stayed in hospital 1 day less with fewer complications. It is unlikely that the intervention causes harm. The balance of current evidence does not support widespread implementation of this approach to reduce mortality but does suggest that complications and duration of hospital stay are reduced.