British journal of anaesthesia
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Review Case Reports
Problems in obtaining sufficient anaesthesia with propofol and remifentanil: three cases, a test infusion, and a review.
Over a 5 yr period, we have encountered three patients in whom remifentanil appeared to have no clinical effect during general anaesthesia (GA). We describe seven anaesthetics in these three patients. ⋯ The potential causes of this effect are discussed. We advise clinicians to be aware of this unusual response to remifentanil. If such a response is suspected, we recommend the use of another opioid. If this is suspected before GA, we propose the use of our test as a diagnostic tool.
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Controlled Clinical Trial
Visual metaphors on anaesthesia monitors do not improve anaesthetists' performance in the operating theatre.
Previous research using a metaphorical anaesthesia monitor, where dimensions of rectangles proportionally represent 30 patient variable values, showed improved performance in diagnosing adverse events compared with the standard monitor. Steady-state values were represented by a frame around each rectangle. We developed a similar metaphorical anaesthesia interface, but instead of presenting four relatively simple complications, we presented 10 complications of various levels of difficulty. Our simplified monitor presented variables that anaesthetists and trainees suggested as being essential for diagnosis. ⋯ Visual metaphors on anaesthesia monitors do not improve anaesthetists' performance in the operating theatre. Since all complications in this study were identifiable based on monitor values alone, it seems feasible to develop a decision support system (DSS) based on these values. We suggest that a DSS could support the anaesthetist by calling attention to diagnoses that may not be considered.
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Symptomatic cerebral hyperperfusion (SCH) is a potential complication after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with moyamoya disease. This retrospective study was designed to determine factors associated with SCH after STA-MCA anastomosis in adult moyamoya patients. ⋯ The operation on the dominant hemisphere and increased postoperative WBC count may be associated with SCH after STA-MCA anastomosis in adult-onset moyamoya patients.