British journal of anaesthesia
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Several risk scores have been developed to calculate the probability of postoperative nausea and vomiting (PONV). However, the power to discriminate which individual will suffer from PONV is still limited. Thus, we wondered how the number of predictors in a score affects the discriminating power and how the characteristics of a population--which is needed to measure the power of a score--may affect the results. ⋯ The currently available simplified risk scores (with four or five predictors) are useful both as a method to estimate individual risk of PONV and as a method for comparing groups of patients for antiemetic trials. They are also superior to single predictor models which are just using the patients' history of PONV or female gender alone. However, our analysis suggests that the power to discriminate which indvidual will suffer from PONV will remain imperfect, even when more predictors are considered.
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Case Reports
Xenon anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome.
There are few reports on anaesthesia for patients with Eisenmenger's syndrome requiring non-cardiac surgery and none of the use of xenon. We describe the use of xenon with a closed-circuit system in a patient with Eisenmenger's syndrome having a laparoscopic cholecystectomy.
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Propofol is used in the peri-operative setting and may affect some neutrophil functions. The effects of propofol on the function and intracellular signal transduction systems of neutrophils is controversial. Mitogen-activated protein kinase families (MAPKs) are members of the intracellular signal-transducing systems in eukaryotes. ⋯ The phosphorylation of p42 MAPK and chemotaxis stimulated by FMLP were both inhibited by propofol at clinically relevant concentrations (> or = 10 and > or = 20 microM respectively). PD98059 (50 microM) also inhibited chemotaxis stimulated by FMLP, suggesting the involvement of p42 MAPK in the response. Propofol might therefore inhibit human neutrophil chemotaxis, at least in part, by suppressing the p44/42 MAPK pathway.
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The level of sedation of 28 patients undergoing elective coronary artery bypass grafting with fentanyl-propofol anaesthesia was monitored with bispectral analysis (BIS), spectral edge frequency, and band power of the electroencephalogram. Fourteen patients underwent hypothermic cardiopulmonary bypass (CPB) (32 degrees C, group H), and 14 normothermic CPB (group N). The level of sedation was measured with Observer's Assessment of Alertness/Sedation Score and with Ramsay Sedation Score. ⋯ During the phases of anaesthesia and surgery without CPB, the progression of BIS levels was comparable with previously published data for non-cardiac surgery. During normothermic CPB, the highest BIS values were close to values representing insufficient depth of sedation. It remains to be elucidated whether the much lower BIS values in the hypothermic group were solely a result of brain cooling or if increased serum propofol concentrations, because of slowed pharmacodynamics during hypothermia, also contributed.
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Hypertension is the commonest avoidable medical indication for postponing anaesthesia and surgery. There are no universally accepted guidelines stating the arterial pressure values at which anaesthesia should be postponed. The aim of this study was to determine the extent of variation across the South-West region of the UK in the anaesthetic management of patients presenting with stage 2 or stage 3 hypertension. ⋯ The response rate was 58%. We found great variability between anaesthetists as to which patients would be cancelled. Departmental protocols may aid general practitioners and surgeons in the preparation of patients for surgery, but such protocols may be difficult to agree in the light of such a wide variation in practice.