British journal of anaesthesia
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Radial artery applanation tonometry technology can be used for continuous non-invasive measurement of arterial pressure (AP). The purpose of this study was to evaluate this AP monitoring technology in intensive care unit (ICU) patients in comparison with invasive AP monitoring using a radial arterial catheter. ⋯ In ICU patients, MAP and DAP measurements obtained using radial artery applanation tonometry show clinically acceptable agreement with invasive AP determination with a radial arterial catheter. While the radial artery applanation tonometry technology also allows SAP measurements with high accuracy, its precision for SAP measurements needs to be further improved.
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Awareness during general anaesthesia for Caesarean section (C/S), although uncommon, remains a concern for anaesthesiologists. We examined the relationship between the bispectral index (BIS) and responses to the isolated forearm technique (IFT) to evaluate the adequacy of general anaesthesia in C/S and determine a suitable cut-off point for BIS values based on IFT results. ⋯ The BIS is not reliable for monitoring anaesthesia depth in C/S. Lower than previously recommended values are needed to avoid IFT test responses during laryngoscopy, intubation, and skin incision.
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Comparative Study
Enhanced antinociceptive efficacy of epidural compared with i.v. methadone in a rat model of thermal nociception.
The properties of methadone suggest a potential advantage for epidural over i.v. administration for pain relief, but little supportive evidence exists. ⋯ Epidural administration of methadone in rats resulted in systemic exposure similar to that after i.v. administration, but improved thermal antinociceptive efficacy, and reduced supraspinal undesired effects. The findings suggest the presence of local effect at the spinal cord level, in addition to the systemic effect produced by epidural methadone.
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Superimposed high-frequency jet ventilation (SHFJV) has proved to be safe and effective in clinical practice. However, it is unclear which frequency range optimizes ventilation and gas exchange. The aim of this study was to systematically compare high-frequency jet ventilation (HFJV) with HFJV by assessing chest wall volume variations (ΔEEV(CW)) and gas exchange in relation to variable high frequency. ⋯ In a porcine model, SHFJV was more effective in increasing end-expiratory volume than single-frequency HFJV, but both modes may provide adequate ventilation in the absence of airway obstruction and respiratory disease, except for HFJV at frequencies ≥300 min(-1).
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Randomized Controlled Trial
Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block.
The routine use of neuromuscular blocking agents reduces the occurrence of unacceptable surgical conditions. In some surgeries, such as retroperitoneal laparoscopies, deep neuromuscular block (NMB) may further improve surgical conditions compared with moderate NMB. In this study, the effect of deep NMB on surgical conditions was assessed. ⋯ Application of the five-point SRS showed that deep NMB results in an improved quality of surgical conditions compared with moderate block in retroperitoneal laparoscopies, without compromise to the patients' peri- and postoperative cardiorespiratory conditions. Trial registration The study was registered at clinicaltrials.gov under number NCT01361149.