British journal of anaesthesia
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Whilst the risk of dying after an operation in the UK is very small, the volume of surgery means that there are 20 000-25 000 deaths each year. For these patients and others who suffer major complications, critical illness often leads to a loss of capacity. If wishes are not discussed in advance, the patients may be excluded from meaningful involvement in decisions affecting their care. ⋯ They indicate that healthcare professionals mostly have a positive view of advance care planning in the perioperative period, and there is little training or educational content available. Despite this, most healthcare professionals report feeling well equipped to have such discussions. Evidence was not found of advance care planning becoming a routine part of training or practice in the care of patients in the lead up to high-risk surgery.
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Randomized Controlled Trial Comparative Study
Desflurane reduces intraoperative remifentanil requirements more than sevoflurane: comparison using surgical pleth index-guided analgesia.
Sevoflurane and desflurane are widely used in balanced anaesthesia in combination with opioid analgesics. The opioid remifentanil is frequently chosen because of its extremely rapid pharmacokinetics. However, intraoperative high-dose remifentanil is associated with increased postoperative pain and rescue analgesic use owing to acute tolerance and opioid-induced hyperalgesia. This study aimed to compare intraoperative remifentanil requirements during equi-minimum alveolar concentration (MAC) sevoflurane and desflurane anaesthesia via surgical pleth index-guided remifentanil administration. ⋯ NCT02830243 (ClinicalTrials.gov).
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Several case reports have described anatomical variations that can cause difficulty with front-of-neck airway access, such as major vessels anterior to the trachea. The prevalence of these anomalies is unknown. ⋯ It is common for patients to have some portion of a major vessel anterior to the trachea at sites where an emergency tracheostomy might be performed.
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Impaired consciousness has been associated with impaired cortical signal propagation after transcranial magnetic stimulation (TMS). We hypothesised that the reduced current propagation under propofol-induced unresponsiveness is associated with changes in both feedforward and feedback connectivity across the cortical hierarchy. ⋯ Propofol-induced loss of consciousness is associated with impaired hierarchical feedforward connectivity assessed by EEG after occipital TMS.