European journal of anaesthesiology
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Randomized Controlled Trial
Smartphone-based behavioural intervention alleviates children's anxiety during anaesthesia induction: A randomised controlled trial.
Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial. ⋯ The behavioural distraction strategies using smartphones were effective in preventing an increase in children's anxiety during anaesthesia induction.
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Randomized Controlled Trial
The effect of prior tetanic stimulation on train-of-four monitoring in paediatric patients: A randomised open-label controlled trial.
In clinical research, neuromuscular monitoring must present a stable response for a period of 2 to 5 min before administration of a neuromuscular blocking agent. The time required to reach this stable response may be shortened by applying a 5-s tetanic stimulus. ⋯ Tetanic stimulation shortened the mean times to normalised TOF ratios of 0.7, 0.8 and 0.9, but there was no difference in the mean onset time or the mean time required for T1 height stabilisation after a single dose of rocuronium 0.6 mg kg followed by spontaneous recovery in children aged 2 to 11 years.
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Randomized Controlled Trial
Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory-motor block: A randomised controlled trial.
To evaluate the efficacy of a nerve stimulator when used with ultrasound-guided double injection in supraclavicular brachial plexus block. ⋯ The MDI technique has a higher success rate for complete sensory block of the ulnar nerve within 15 min of local anaesthetic injection. The time needed to perform the block is about 1 min longer than the traditional technique.
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Multicenter Study Observational Study
A survey of the dose of inhalational agents used to maintain anaesthesia in infants.
Various animal studies suggest that currently used anaesthetics are toxic to the developing brain. Many reviews advise that the total anaesthetic drug exposure should be reduced but the dose usually used in clinical practice has not been clearly elucidated. ⋯ The concentration of inhalational anaesthetics in %MAC increased with age and was lowest in neonates. Most young infants received inhalational anaesthetics at a concentration below 1 MAC, which accords with current guidance to minimise anaesthetic drug exposure but may have unintended consequences.
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Regarding nerves as simple cables and electrical conduits is a gross error that does not allow us to understand the anomalies and disorders observed postoperatively. Instead, nerves should be seen as a living tissue of which physiological regulation is as complex as that of the blood-brain barrier. This review describes the basic structure and functions of this blood-nerve barrier and highlights the mechanisms of its breakdown and the resultant disorders. ⋯ This blood supply can adapt in a variety of ways but when these possibilities of adaptation are exceeded, tissue ischaemia may be more extensive. Also, even after the initial injury has subsided, inflammation can cause a secondary insult. This could be particularly important in some patients with subclinical neuropathy.