British journal of anaesthesia
-
Editorial Review
Neuroanatomical and pharmaco-physiological effects of hypoxia and esketamine on breathing, the sympathetic nerve system, and cortical function.
Acute hypoxic ventilatory response is an important reflex that helps maintain breathing during low oxygen levels, but it is attenuated by most general anaesthetics. Analgesic doses of ketamine and esketamine are known to have respiratory stimulant effects. ⋯ Participants also exhibited higher levels of alertness and unpleasant psychotropic effects compared with the control condition. We review the pharmaco-physiological effects of acute hypoxia and its interactions with esketamine. We provide a summary of the effects of hypoxia and esketamine on the neurocircuitry that leads to arousal, activation of the sympathetic nerve system, and increased drive to upper airway dilator and respiratory pump muscles.
-
Multicenter Study
Evaluation of point-of-care haemoglobin measurement accuracy in surgery (PREMISE) and implications for transfusion practice: a prospective cohort study.
Point-of-care testing devices to measure haemoglobin (Hgb) frequently inform transfusion decision-making in surgery. This study aimed to examine their accuracy in surgery, focusing on Hgb concentrations of 60-100 g L-1, a range with higher potential for transfusion. ⋯ No point-of-care Hgb device demonstrated limits of agreement that were smaller than the agreement difference of 4 g L-1. Despite this, HemoCue can be safely used to inform transfusion decisions in surgery, given its error probability of <4% in transfusion scenarios.
-
Multicenter Study
Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies.
Optimised use of kidney function information might improve cardiac risk prediction in noncardiac surgery. ⋯ ClinicalTrials.gov NCT00512109 (VISION) and NCT01082874 (POISE-2).
-
Intravenous lidocaine is increasingly used as a nonopioid analgesic, but how it acts in the brain is incompletely understood. We conducted a functional MRI study of pain response, resting connectivity, and cognitive task performance in volunteers to elucidate the effects of lidocaine at the brain-systems level. ⋯ NCT05501600.
-
Editorial Letter
NAP7: high mortality risk in neonates and very low risk in children.
Editor-We congratulate Lyne and colleagues1 on their initiative to explore and improve consent around perioperative mortality in children. Providing such data for families and clinicians is a key purpose of the Royal College of Anaesthetists' National Audit Projects (NAPs), and to this end, NAP7 studied perioperative cardiac arrest.2-4.