Anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of remifentanil with and without atropine on heart rate variability and RR interval in children.
Remifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. ⋯ Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed.
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Brain stem death may be a difficult concept for relatives to understand. Our ITU practice follows published recommendations that the use of explanatory leaflets showing CT scans and observing brain stem death testing in some cases may help relatives to understand that death has occurred. Using this strategy, we interviewed 27 relatives 12 months after bereavement following certification by brain stem testing, investigating their understanding of brain stem death, subsequent attitudes to organ donation, grief reactions and attitudes of those who had observed the tests. ⋯ Only five relatives observed the tests, all were pleased that they had done so as this had confirmed their understanding that death had occurred; however, these relatives had more evidence of psychological distress. No relatives who agreed to organ donation regretted this but three who did not allow donation subsequently expressed regret. Several relatives thought that observing the tests would have helped them to understand that death had occurred, making easier the decision to allow organ donation.
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Case Reports
Use of remifentanil for tracheal intubation for caesarean section in a patient with suxamethonium apnoea.
A parturient presented for elective caesarean section with a history of multiple spinal operations and scoliosis and a biochemical diagnosis of suxamethonium apnoea. She declined any attempt at regional anaesthesia. ⋯ The parturient awoke following an uneventful caesarean section with excellent pain relief and no recall. The baby had normal Apgar scores and umbilical blood gas measurements.