European journal of anaesthesiology
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Review Historical Article
Anaesthetic mechanisms: update on the challenge of unravelling the mystery of anaesthesia.
General anaesthesia is administered each day to thousands of patients worldwide. Although more than 160 years have passed since the first successful public demonstration of anaesthesia, a detailed understanding of the anaesthetic mechanism of action of these drugs is still lacking. An important early observation was the Meyer-Overton correlation, which associated the potency of an anaesthetic with its lipid solubility. ⋯ Yet these accumulated data have not produced a comprehensive explanation for how these drugs produce central nervous system depression. In this review, we follow the story of anaesthesia mechanisms research from its historical roots to the intensely neurophysiological research regarding it today. We will also describe recent findings that identify specific neuroanatomical locations mediating the actions of some anaesthetic agents.
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Randomized Controlled Trial
Intravenous morphine and droperidol after caesarean delivery under subarachnoid anaesthesia has no effect on postoperative pain or analgesic requirements.
Opioids are routinely administered to obtain a better control of postoperative pain. The aim of the present study was to assess the intravenous morphine effect after caesarean delivery on the postoperative morphine requirements and pain. ⋯ Morphine given after caesarean delivery under subarachnoid anaesthesia has no effect on analgesic requirements or acute postoperative pain.
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We studied whether changes in less invasive, noncalibrated pulse-contour cardiac output (by modified ModelFlow, COmf) and derived stroke volume variations (SVV), as well as systolic and pulse pressure variations, predict changes in bolus thermodilution cardiac output (COtd), evoked by continuous and cyclic increases in intrathoracic pressure by increases in positive end-expiratory pressure (PEEP) and tidal volume (Vt), respectively. ⋯ A fall in COmf is more sensitive than a rise in SVV, which is more sensitive than systolic pressure variation and pulse pressure variation, in tracking a fall in COtd during continuous (and not cyclic) increases in intrathoracic pressure, in mechanically ventilated patients after cardiac surgery. This suggests a reduction in biventricular preload as the main factor in decreasing cardiac output and increasing SVV with PEEP.
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In the majority of patients with difficult airways intubated using the Bonfils fibrescope, intubations have been performed under general anaesthesia. Our aim is to report a consecutive series of intubations on awake patients with anticipated difficult airways, performed using the Bonfils fibrescope. ⋯ Our findings confirm that awake intubation with the Bonfils fibrescope is well tolerated and highly successful, even if performed by operators in training, and strengthen the evidence that the Bonfils fibrescope is one of the most promising devices to assist intubation in patients with difficult airways.
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Letter Case Reports Comparative Study
Performance of Vigileo and LiDCOplus cardiac output monitors during a prolonged cardiac arrest and resuscitation.