British journal of anaesthesia
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Randomized Controlled Trial
Effect of propofol on the medial temporal lobe emotional memory system: a functional magnetic resonance imaging study in human subjects.
Subclinical doses of propofol produce anterograde amnesia, characterized by an early failure of memory consolidation. It is unknown how propofol affects the amygdala-dependent emotional memory system, which modulates consolidation in the hippocampus in response to emotional arousal and neurohumoral stress. We present an event-related functional magnetic resonance imaging study of the effects of propofol on the emotional memory system in human subjects. ⋯ NCT00504894.
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Train-of-four (TOF) fade during nerve-mediated muscle contraction is postulated to be attributable to inhibition of prejunctional nicotinic α3β2 acetylcholine receptors (nAChRs), while decrease of twitch tension is attributable to block of postjunctional muscle nAChRs. The validity of these presumptions was tested using specific prejunctional and postjunctional nAChR antagonists, testing the hypothesis that fade is not always a prejunctional phenomenon. ⋯ Occupation of postjunctional nAChRs alone by α-BTX or α-conotoxin GI causes fade. As the prejunctional effects of DHβE on fade became manifest only when co-administered with α-BTX or α-conotoxin GI, specific inhibition of prejunctional nAChR alone is not necessary and sufficient to cause fade. Fade observed during repetitive nerve stimulation can be because of block of either postjunctional nAChRs alone, or block of prejunctional and postjunctional nAChRs together.
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Randomized Controlled Trial
Early cryoprecipitate for major haemorrhage in trauma: a randomised controlled feasibility trial.
Low fibrinogen (Fg) concentrations in trauma haemorrhage are associated with poorer outcomes. Cryoprecipitate is the standard source for Fg administration in the UK and USA and is often given in the later stages of transfusion therapy. It is not known whether early cryoprecipitate therapy improves clinical outcomes. The primary aim of this feasibility study was to determine whether it was possible to administer cryoprecipitate, within 90 min of admission to hospital. Secondary aims were to evaluate laboratory measures of Fg and clinical outcomes including thrombotic events, organ failure, length of hospital stay and mortality. ⋯ Early Fg supplementation using cryoprecipitate is feasible in trauma patients. This study supports the need for a definitive RCT to determine the effect of early Fg supplementation on mortality and other clinical outcomes.
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The transport of the seriously injured patient is associated with risk and requires particular expertise and attention. The aim of this review is to provide a historical overview of transport services available to trauma patients in the UK, describe the various transport platforms that are used, identify risks from a system and disease perspective and how they may be mitigated, and make international comparisons. The transfer of patients requiring medical attention has developed over the years and now includes complex undertakings that undoubtedly confer a degree of risk on the patient. ⋯ When deciding to transport an injured patient, there are risks, and appropriate mitigation must be in place, particularly if primary transfer to a major trauma centre involves bypassing a nearer facility. It is clear that those clinicians who undertake medical transfers must be appropriately trained and must have access to local or national guidelines. Medical transfers must be the subject of ongoing research, both to ensure that best practice is in place and to continue to understand the safest way of achieving essential transfers effectively.