European journal of anaesthesiology
-
Several previous studies using univariate analysis have suggested that the pre-anaesthetic train-of-four (TOF) ratio, concentration of anti-acetylcholine receptor (AChR) antibodies and the presence of preoperative generalised muscular involvement are determinants of an increased response to neuromuscular blocking agents (NMBAs) in patients with myasthenia gravis. However, the determinants of the response of patients with myasthenia gravis to rocuronium, which is expected to be used more frequently since the advent of sugammadex, have not been studied. ⋯ Multivariate analysis identified baseline TOF ratio and age of disease onset as determinants of the increased response to rocuronium in patients with myasthenia gravis.
-
Comparative Study Observational Study
Persistent posthysterectomy pain: A prospective, observational study.
There is a large variation in the prevalence of persistent postsurgical pain depending on the type of surgery. It is unclear how common persistent postsurgical pain is after vaginal or laparoscopic hysterectomy. ⋯ Persistent posthysterectomy pain is common, but pain is mild and does not interfere with daily activities for most of the patients 6 months after surgery. Smoking is the strongest predictor for persistent pain.
-
Observational Study
Predictors of the variability in neuromuscular block duration following succinylcholine: A prospective, observational study.
The duration of neuromuscular block (NMB) following succinylcholine administration is characterised by a high interindividual variability. However, this has not yet been quantified in a large sample of surgical patients. The significance of underlying clinical factors is unknown. ⋯ Neuromuscular blockade duration in excess of 10 min occurred in 16% of a general surgical population following a single dose of succinylcholine. The multivariable model of clinical risk factors for prolonged NMB revealed a negative predictive value of 87%, thereby indicating that absence of such risk factors may reliably predict a shorter duration of NMB. In patients with clinical risk factors for a prolonged NMB or with butyrylcholinesterase mutations, an alternative to succinylcholine should be considered.
-
Observational Study
Preoperative glycosylated haemoglobin as a predictor of postoperative analgesic requirements in diabetic patients: A prospective observational study.
In diabetic individuals undergoing surgery, the analgesic effect of opioids on postoperative pain may be different from normal. Although the ability of glycosylated haemoglobin (HbA1c) to predict adverse events and outcomes after major surgery has recently been assessed, the ability of HbA1c to predict the need for postoperative analgesia has not been determined. ⋯ This study demonstrated that in diabetic patients, the preoperative level of HbA1c was associated with the postoperative fentanyl consumption. In diabetic patients, the HbA1c level prior to surgery may be useful in anticipating postoperative analgesic requirements and help to improve patient counselling regarding postoperative pain.
-
Opioid analgesia not only reduces inhalational anaesthetic requirements but may also induce delayed hyperalgesia, with potential effects on the minimum alveolar concentration (MAC) of inhalational anaesthetics. ⋯ Tramadol-induced hyperalgesia in the rat lasted for several weeks and was associated with an increase in the MAC of sevoflurane. Prior administration of ketamine blocked both phenomena.