British journal of anaesthesia
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Ketamine, an N-methyl-D-aspartic acid receptor antagonist that was first discovered in 1962, has become established in anaesthesia providing dose-dependent anaesthetic, sedative, and analgesic effects. Ketamine, however, also acts on a wide range of other cellular targets, resulting in interesting and diverse effects on both physiological and pathological processes. Potential beneficial properties of ketamine include cardiovascular stability for patients undergoing sedation or anaesthesia, analgesia in both acute and chronic pain, bronchodilation in severe refractory asthma, anti-inflammatory properties particularly in sepsis, tumour inhibition, and antidepressant properties with marked ability to reverse suicidal ideation. ⋯ This review explores the diverse properties and therapeutic potentials of ketamine being investigated across different fields whilst also identifying areas for ongoing and future research. Given the diverse range of potential benefits and promising early work, ketamine should be the focus of ongoing research in multiple different specialty areas. This includes areas relevant to anaesthesia and perioperative medicine, such as acute and chronic pain management, ICU sedation, and even tumour suppression in those undergoing surgical resection of malignancies.
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Telemedicine may help improve care quality and patient outcomes. Telemedicine for intraoperative decision support has not been rigorously studied. ⋯ NCT03923699.
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Review Meta Analysis Comparative Study
Comparison of different monitors for measurement of nociception during general anaesthesia: a network meta-analysis of randomised controlled trials.
To avoid underdosing or overdosing of analgesic medications, a variety of nociception monitors that use distinct techniques have been developed to quantify nociception during general anaesthesia. Although prior meta-analyses have examined the behaviour of nociception monitors vs standard care protocols, they did not include the potentially valuable data for monitor-to-monitor comparisons. In order to capture these data fully and compare the behaviour of these monitors, we conducted a systematic search and network meta-analysis. ⋯ Apart from pupillometry, no monitors demonstrated a significant effect on intraoperative opioid consumption. Secondary outcomes indicate limited clinical benefit for patients when using these monitors.
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Multicenter Study
Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort.
Sugammadex hypersensitivity is between 1 in 12,5000 and 1 in 50,000 perioperative exposures.
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Postoperative anxiety and depression can negatively affect surgical outcomes and patient wellbeing. This study aimed to quantify the incidence of postoperative worsening anxiety and depression symptoms and to identify preoperative predictors of these conditions. ⋯ Postoperative worsening anxiety and depression appear to be associated more closely with preoperative active mental health or pain symptoms rather than self-reported history of these conditions. Preoperative identification of at-risk patients will require screening for symptoms rather than simple history taking.