British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparing the effects of stimulation and propofol infusion rate on implicit and explicit memory formation.
Doubt remains about the conditions under which learning persists despite anaesthesia. This study investigated the relative importance of dose of anaesthetic and stimulation for learning during propofol infusion before surgery. Thirty-six patients were randomly assigned to three groups. ⋯ To establish baseline, a control group of 12 patients completed the category generation test without receiving the category examples during anaesthesia. Overall, there was no evidence for learning during propofol infusion, though the category generation task showed a trend towards more implicit memory for words presented during intubation than during anaesthesia. We conclude that learning does not occur during anaesthesia without surgery.
-
Randomized Controlled Trial Clinical Trial
Epidural analgesia and arterial reconstructive surgery to the leg: effects on fibrinolysis and platelet degranulation.
It has been suggested that the incidence of early graft occlusion after arterial reconstructive surgery to the leg may be decreased by epidural analgesia. This effect may be mediated by the suppression of the usual cortisol response to surgery, which results in increased circulating plasminogen activator inhibitor-1 with consequent adverse effects on fibrinolysis. To investigate this and other potential mechanisms, 30 patients undergoing arterial reconstructive surgery to the leg were randomized to receive either general anaesthesia or general anaesthesia plus epidural analgesia. ⋯ Interleukin-6 values increased significantly in both groups after 4 h and remained elevated until day 3. There were no significant differences between the groups in any variable measured. We conclude that any effect of epidural analgesia on early graft patency is unlikely to be mediated by fibrinolysis or platetlet degranulation.
-
Practice Guideline Guideline
Guidelines for molecular genetic detection of susceptibility to malignant hyperthermia.
Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disease triggered by several anaesthetic agents. The in vitro muscle contracture test (IVCT) is the standard test to establish an individual's risk of susceptibility to MH. Clinical practitioners and geneticists of the European MH Group have agreed on the present guidelines for the detection of MH susceptibility using molecular genetic techniques and/or IVCT to predict the risk of MH.
-
Comparative Study
EEG bispectral index and hypnotic component of anaesthesia induced by sevoflurane: comparison between children and adults.
This prospective study was designed to evaluate the correlation between the electroencephalographic bispectral index (BIS) and the hypnotic component of anaesthesia (CA) induced by sevoflurane in 27 children and 27 adult patients. BIS and CA were compared at loss of consciousness (LOC) and on recovery of consciousness (ROC). Mean (SD) BIS decreased significantly at LOC in children and adults from 94 (2.7) to 87.4 (4) and from 96.2 (2) to 86.7 (4.4), respectively, without any difference between groups. ⋯ Correlation coefficients between BIS and CA in ROC were -0.876 in children and -0.837 in adults. BIS values at ROC were not different from those at LOC in either group. These data demonstrate that BIS correlates with the hypnotic component of anaesthesia induced by sevoflurane in children as well as in adults.
-
Comparative Study
Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children.
Chin lift, jaw thrust and these manoeuvres combined with continuous positive airway pressure (CPAP) can be used to improve the patency of the upper airway during general anaesthesia. We used video endoscopy and measurement of stridor to compare the efficacy of these manoeuvres in 24 children (3-10 yr) with adenotonsillar hyperplasia. ⋯ Both chin lift plus CPAP and jaw thrust plus CPAP reduced stridor significantly compared with the unsupported condition. In conclusion, in spontaneously breathing children with large tonsils, chin lift plus CPAP is recommended, whereas jaw thrust plus CPAP is no better and may cause post-operative discomfort.