British journal of anaesthesia
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Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended awareness from the patient's perspective with an emphasis on their experiences and healthcare provider responses. ⋯ Data from this registry confirm the serious impact of anaesthesia awareness for some patients, and suggest that patients need more systematic responses and follow-up by healthcare providers.
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As opposed to conscious, personally relevant (explicit) memories that we can recall at will, implicit (unconscious) memories are prototypical of 'hidden' memory; memories that exist, but that we do not know we possess. Nevertheless, our behaviour can be affected by these memories; in fact, these memories allow us to function in an ever-changing world. It is still unclear from behavioural studies whether similar memories can be formed during anaesthesia. ⋯ Function of sensory cortices and thalamic activity during anaesthesia are reviewed. The role of sensory and perisensory cortices, in particular the auditory cortex, in support of memory function is discussed. Although improbable, with the current knowledge of neurophysiology one cannot rule out the possibility of memory formation during anaesthesia.
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Anaesthetic drugs act at sites within the brain that undergo profound changes during typical ageing. We postulated that anaesthesia-induced brain dynamics observed in the EEG change with age. ⋯ These profound age-related changes in the EEG are consistent with known neurobiological and neuroanatomical changes that occur during typical ageing. Commercial EEG-based depth-of-anaesthesia indices do not account for age and are therefore likely to be inaccurate in elderly patients. In contrast, monitoring the unprocessed EEG and its spectrogram can account for age and individual patient characteristics.
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Observational Study
Fibrinogen plasma concentration before delivery is not associated with postpartum haemorrhage: a prospective observational study.
Low plasma fibrinogen concentration has been linked to postpartum haemorrhage. The primary aim of this study was to assess whether fibrinogen concentration at admission before labour is associated with severe postpartum haemorrhage. Secondary aims were to describe fibrinogen concentration before and after labour and to identify predictors for severe postpartum haemorrhage. ⋯ Fibrinogen plasma concentration at admission before labour does not predict severe postpartum haemorrhage in a general obstetric population. Fibrinogen concentration does not decrease significantly during normal labour. Excessive postpartum bleeding is mainly as a result of obstetric complications.
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The isolated forearm technique (IFT) enables an otherwise paralysed patient to communicate awareness to the anaesthetist. We present a debate that focuses on how best to interpret IFT responses. On one side, Pandit argues that there is a range of response types from none through to movement initiated by the patient to alert the researcher. ⋯ In rebuttal, Russell and Wang argue that IFT response types are not so discrete, and that the IFT technique precludes higher levels of response. They argue that overinterpretation of IFT responses might in fact result in a greater risk of accidental awareness; a binary interpretation of the IFT response is the safest option. All authors agree that the IFT has a role in clinical practice and the study of anaesthetic mechanisms.