European journal of anaesthesiology
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Clinical Trial
Thoracic but not lumbar epidural anaesthesia increases liver blood flow after major abdominal surgery.
Epidural blockade in major abdominal surgery bears the potential to increase gastrointestinal perfusion and thus to improve patient outcome. The aim of this study was to assess the differential influence of thoracic and lumbar epidural anaesthesia and analgesia (EAA) on blood lactate levels and central venous oxygen saturation (ScvO2) as parameters of global oxygen supply/demand ratio, as well as on the plasma disappearance rate of indocyanine green (PDR(ICG)), a noninvasive method to evaluate liver perfusion. ⋯ Liver perfusion was increased with thoracic but not lumbar EAA after major abdominal surgery in most patients. PDR(ICG) allows assessment of individual changes of liver blood flow due to therapeutic intervention, for example, EAA.
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Randomized Controlled Trial
Delta sleep-inducing peptide alters bispectral index, the electroencephalogram and heart rate variability when used as an adjunct to isoflurane anaesthesia.
Delta sleep-inducing peptide (DSIP) is an endogenous peptide that crosses the blood-brain barrier, named after its association with natural sleep and enhanced electroencephalogram (EEG) delta rhythm. The objective of this study was to determine whether DSIP could be used as an adjunct to volatile anaesthesia in humans, our hypothesis being that DSIP is a natural hypnotic that would increase anaesthetic depth. The aims were to assess depth of anaesthesia using bispectral index (BIS), the EEG and heart rate variability (HRV), and to determine whether DSIP altered the symmetry of EEG between the left and right cerebral hemispheres. ⋯ DSIP probably reduced parasympathetic tone and decreased (lightened) the depth of anaesthesia measured using BIS.
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Randomized Controlled Trial
Effect of preoperative intravenous carbohydrate loading on preoperative discomfort in elective surgery patients.
We studied the effect of three different fasting protocols on preoperative discomfort and glucose and insulin levels. ⋯ Intravenous glucose infusion does not decrease the sense of thirst and hunger as effectively as a carbohydrate-rich drink but does alleviate the feelings of weakness and tiredness compared with fasting.
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Conventional analgesics have limited efficacy in the management of neuropathic pain. An adjuvant analgesic is a drug that has a primary nonpain indication but which may be analgesic in certain circumstances, and many of these have established a role in the pharmacological treatment of neuropathic pain. ⋯ Cost-effectiveness data are absent for the vast majority of these drugs. Pharmacological treatments should be used as part of a multimodal therapeutic programme for the management of neuropathic pain.
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Randomized Controlled Trial
Effects of desflurane, sevoflurane and propofol on phagocytosis and respiratory burst activity of human polymorphonuclear leucocytes in bronchoalveolar lavage.
In polymorphonuclear leucocytes, phagocytosis and respiratory burst activity are mainly responsible for bacterial killing. We aimed to investigate the effects of anaesthesia with desflurane, sevoflurane and propofol on these functional activities of polymorphonuclear leucocytes in bronchoalveolar lavage fluid. ⋯ This study showed that propofol anaesthesia increased the respiratory burst function of polymorphonuclear leucocytes in bronchoalveolar lavage fluid.