European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Controlled hypotension in adults undergoing choroidal melanoma resection: comparison between the efficacy of nitroprusside and magnesium sulphate.
To determine whether magnesium sulphate could induce controlled hypotension, reduce choroidal blood flow, provide a 'dry' operative field and could be compared with sodium nitroprusside in the recently raised issue of the use of hypotensive anaesthesia in eye surgery, i.e. for choroidal tumour surgery as the choroid is the most fragile and vascular structure in the eye. ⋯ Magnesium sulphate controlled hypotension, reduced intraoperative pressure and provided good surgical conditions for choroidal melanoma resection with no need for additional use of a potent hypotensive agent in adults.
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Randomized Controlled Trial
The performance of Bispectral Index in children during equi-MAC halothane vs. sevoflurane anaesthesia.
The reliability of the Bispectral Index for evaluating and monitoring the depth of general anaesthesia in children is not as great as for that in adults. Therefore we analysed Bispectral Index performance in children by comparing changes in Bispectral Index values during a standardized and equipotent anaesthetic regimen using either halothane or sevoflurane for the induction and maintenance of general anaesthesia. Special interest was focussed on excitation during induction, and whether it was associated with simultaneous changes in Bispectral Index scores. ⋯ In children, halothane anaesthesia was associated with higher Bispectral Index values than sevoflurane when administered at 1 MAC. Large individual variation in Bispectral Index occurred within both groups. Due to these limitations, one should be cautious when interpreting paediatric Bispectral Index data.
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Randomized Controlled Trial
Postoperative pain status after intraoperative systemic dexmedetomidine and epidural neostigmine in patients undergoing lower abdominal surgery.
To determine whether intraoperative systemic dexmedetomidine improves postoperative pain and interacts with epidural neostigmine to produce analgesic effects. ⋯ The intraoperative systemic infusion of dexmedetomidine alone at doses causing sedation does not result in postoperative analgesic effects. However, the co-administration of systemic dexmedetomidine and epidural neostigmine at higher doses may be a useful method to improve postoperative pain although side-effects have to be evaluated.
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Because patients who are to undergo surgery must give their consent to planned postoperative care, clear and complete information on postoperative pain management should be given. The aim of this quality-of-care study was to evaluate by inquiry the impact of written information describing postoperative pain management on the quality and type of information retained, and patient participation in discussing and agreeing to the postoperative pain management programme during the presurgical anaesthesiology consultation. ⋯ Written information on postoperative pain management distributed before the presurgical anaesthesiology consultation improved the quality of information retained, facilitated discussion with the anaesthesiologist and patient agreement with the postoperative pain management programme.
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Pumpless arteriovenous extracorporeal lung assist is increasingly used as a rescue therapy in acute respiratory distress syndrome. Arteriovenous extracorporeal lung assist is highly efficient in eliminating carbon dioxide and allows the application of ventilator techniques that prioritize lung protection and aim to reduce ventilator-induced lung injury and remote organ dysfunction. ⋯ A multimodal treatment concept with arteriovenous extracorporeal lung assist as its central part provides reversal of hypercapnia and stabilization of oxygenation. In an attempt to maximize lung protection and potentially reduce ventilator-induced lung injury, a further VT reduction below 4 mL kg(-1) predicted body weight combined with a high mean airway pressure and continuous axial rotation is safely possible.