British journal of anaesthesia
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Depth of anaesthesia (DOA) monitors based on the electroencephalogram (EEG) are commonly used in anaesthetic practice. Their technology relies on mathematical analysis of the EEG waveform, generally resulting in a number which corresponds to anaesthetic depth. We have created a novel method of interpreting the EEG, which retains its underlying complexity. This method consists of turning the EEG into a sound: the electroencephalophone (EEP). ⋯ The EEP shows promise as a DOA monitor. However, extensive validation would be required in a variety of clinical settings before it could be accepted into mainstream clinical practice.
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Teaching epidural catheter insertion tends to focus on developing manual dexterity rather than improving aseptic technique which usually remains poor despite increasing experience. The aim of this study was to compare epidural aseptic technique performance, by novice operators after a targeted teaching intervention, with operators taught aseptic technique before the intervention was initiated. ⋯ Procedure-specific aseptic technique teaching, aided by video assessment and video demonstration, helped significantly improve aseptic practice by novice trainees. Future studies should consider looking at retention over longer periods of time in more senior residents.
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Cerebral blood flow (CBF) is regulated by vasomotor, chemical, metabolic, and neurogenic mechanisms. Even though the innervation of cerebral arteries is quite extensively described and reviewed in the literature, its role in regulation of CBF in humans remains controversial. We believe that insufficient attention has so far been focused on the potential role of the innervation of the cerebral vasculature in cerebral autoregulation in humans. ⋯ We postulate that under normal physiological conditions neurogenic control has little influence on cerebral autoregulation as other methods of control (vasomotor, chemical, and metabolic) are dominant. In severely challenging circumstances, such as delayed cerebral ischaemia after subarachnoid haemorrhage, these methods might be overwhelmed, increasing the relative importance of neurogenic, sympathetic control of CBF. This insight might lead to future therapeutic possibilities.