British journal of anaesthesia
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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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Letter Randomized Controlled Trial
Evaluation of the D-FLECT® deflectable-tip bougie in a manikin with a simulated difficult airway.
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Observational Study
Proteolysis in septic shock patients: plasma peptidomic patterns are associated with mortality.
Uncontrolled proteolysis contributes to cell injury and organ dysfunction in animal models of circulatory shock. We investigated in humans the relationship between septic shock, proteolysis, and outcome. ⋯ NCT02141607.
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Discrepancy between a patient's subjective thermal symptoms and objective measured temperature value is common in complex regional pain syndrome (CRPS) in clinical settings. For that reason, the diagnostic validity of a single temperature measurement method has been criticised. Several studies showed that the perfusion index (PI), which is derived from pulse oximetry, is a more sensitive and earlier indicator of sympathetic blockade than temperature measurement. ⋯ The accuracy of detection of subjective abnormal thermal sensations was superior for PI compared with the temperature measurement method. PI was a more sensitive measure for detecting vasomotor symptoms in CRPS compared with temperature.
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Prevention of persistent pain after breast cancer surgery, via early identification of patients at high risk, is a clinical need. Psychological factors are among the most consistently proposed predictive parameters for the development of persistent pain. However, repeated use of long psychological questionnaires in this context may be exhaustive for a patient and inconvenient in everyday clinical practice. ⋯ Using a data-driven machine-learning approach, a short list of seven items from BDI and STAI is proposed as a basis for a predictive tool for the persistence of pain after breast cancer surgery.