European journal of anaesthesiology
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State entropy and burst suppression ratio can show contradictory information: A retrospective study.
Burst suppression is a characteristic electroencephalographic (EEG) pattern that reflects very deep levels of general anaesthesia and may correlate with increased risk of adverse outcomes such as postoperative delirium. EEG-based monitors such as the Entropy Module estimate the level of anaesthesia (state entropy) and provide another index reflecting the occurrence of burst suppression, that is the ratio of burst and suppression (BSR). In the Entropy Module, state entropy and BSR are not interconnected, as they are in the bispectral index (BIS). Hence, state entropy and BSR may provide contradicting information regarding the level of anaesthesia. ⋯ Our results illustrate contradictory state entropy and BSR indices that may be relevant for anaesthesia navigation. Longer-lasting episodes may lead to incorrect titration of the depth of the hypnotic component of anaesthesia. Hence, our results demonstrate the necessity to monitor and check the raw EEG or EEG parameters that are less processed than the commercially available indices to safely navigate anaesthesia.
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Randomized Controlled Trial
Effect of spontaneous breathing on atelectasis during induction of general anaesthesia in infants: A prospective randomised controlled trial.
Atelectasis occurs commonly during induction of general anaesthesia in children, particularly infants. ⋯ Maintaining spontaneous ventilation during induction of general anaesthesia has a preventive effect against atelectasis in infants younger than 1 year of age, particularly in the dependent portions of the lungs.
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Randomized Controlled Trial
Intranasal dexmedetomidine versus oral midazolam premedication to prevent emergence delirium in children undergoing strabismus surgery: A randomised controlled trial.
Dexmedetomidine is being used increasingly as a premedicant in the paediatric population. However, the effectiveness of pre-operative intranasal dexmedetomidine premedication, compared with oral midazolam, for emergence delirium is not well characterised. ⋯ In paediatric patients undergoing strabismus surgery intranasal dexmedetomidine 2 μg kg premedication decreases the incidence of emergence delirium and PONV, and improves parents' satisfaction compared with oral midazolam.
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Fluid loading is one of the recognised measures to prevent hypotension due to spinal anaesthesia in women scheduled for a caesarean section. ⋯ Unlike previous meta-analysies, we found a lack of data obviating an evidence-based recommendation. In most studies, vasopressors were not given prophylactically as is recommended. Studies on the best fluid regimen in combination with prophylactic vasopressors are needed. Due to official european usage restrictions on the most studied colloid (HES), we recommend crystalloid coload as the most appropriate fluid regimen.
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Randomized Controlled Trial
Preoperative dexamethasone for pain relief after total knee arthroplasty: A randomised controlled trial.
Corticosteroids can reduce pain but the optimal dose and safety profiles are still uncertain. ⋯ Dexamethasone 16 mg given before total knee arthroplasty led to a reduction in postoperative pain, less opioid consumption, stronger quadriceps muscle power, better mobilisation and better overall quality-of-recovery after operation. No long-term improvement in reduction in pain and function of the knee was found.