Anesthesiology
-
Randomized Controlled Trial Comparative Study
Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial.
Intraoperative awareness with explicit recall occurs in approximately 0.15% of all surgical cases. Efficacy trials based on the Bispectral Index® (BIS) monitor (Covidien, Boulder, CO) and anesthetic concentrations have focused on high-risk patients, but there are no effectiveness data applicable to an unselected surgical population. ⋯ This negative trial could not detect a difference in the incidence of definite awareness or recovery variables between monitoring protocols based on either BIS values or anesthetic concentration. By post hoc analysis, a protocol based on BIS monitoring reduced the incidence of definite or possible intraoperative awareness compared with routine care.
-
Randomized Controlled Trial
Effect of subanesthetic ketamine on intrinsic functional brain connectivity: a placebo-controlled functional magnetic resonance imaging study in healthy male volunteers.
The influence of psychoactive drugs on the central nervous system has been investigated with positron emission tomography and task-related functional magnetic resonance imaging. However, it is not known how these drugs affect the intrinsic large-scale interactions of the brain (resting-state functional magnetic resonance imaging connectivity). In this study, the effect of low-dose S(+)-ketamine on intrinsic brain connectivity was investigated. ⋯ Changes in connectivity were observed in the areas that explain ketamine's pharmacodynamic profile with respect to analgesia and psychedelic and other side effects. In addition, pain and ketamine changed brain connectivity in areas involved in endogenous pain modulation.
-
Anesthesiologists deliver large quantities of verbal information to patients during preoperative teaching. Basic principles of cognitive psychology dictate that much of this information is likely to be forgotten. Exactly how much and what type of information can be retained and recalled remains an open question. ⋯ Under realistic conditions for recall, most medical instruction given to patients will not be recalled, even if it is initially encoded. Given the limits of short-term memory, clinicians should carefully consider their patterns of information giving. Improvement of memory performance with cues for retrieval indicates that providing printed instructions for later review may be beneficial.