British journal of anaesthesia
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We measured breath interval to characterize the time course of opioid effect in anaesthetized patients breathing spontaneously during knee replacement surgery with concurrent regional nerve blockade. Breath interval was recorded before and after a single dose of fentanyl 0.75 microgram kg-1 i.v. Breath interval was measured between the start of successive inspirations, identified by a decrease in carbon dioxide concentration, sampled at the laryngeal mask connection. ⋯ End-tidal carbon dioxide concentrations increased from a baseline of 6.6 (0.9)% to a peak of 8.2 (0.8)%. Breath interval was a useful and reproducible method of monitoring the duration of opioid effect in anaesthetized patients breathing spontaneously when surgical stimulation was not affecting the CNS. The data provide information on the duration of action of fentanyl and could guide dosage.
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Bispectral index (BIS) was assessed as a monitor of depth of anaesthesia during fentanyl and midazolam anaesthesia for coronary bypass surgery. In 10 patients given morphine premedication, anaesthesia was induced with a combination of midazolam and fentanyl and thereafter maintained with a continuous infusion of a mixture of midazolam and fentanyl 5 and 50 micrograms kg-1 h-1, respectively. BIS was recorded continuously but not shown to the attending anaesthetist. ⋯ No patient reported explicit or implicit recall. During clinically adequate anaesthesia with midazolam and fentanyl BIS varies considerably. The most likely reason is that BIS is not an accurate measure of the depth of anaesthesia when using this combination of agents.
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Needlestick injury is relatively common amongst healthcare workers, particularly those, such as anaesthetists, who regularly perform invasive procedures. The risk of seroconversion following needlestick injury may be reduced by knowledge of body fluids that are high risk and knowledge of post-exposure prophylaxis following possible HIV-contaminated needlestick injury. A structured questionnaire was used to establish knowledge regarding high HIV risk body fluids and measures to be taken following needlestick injury in anaesthetists working in a large teaching hospital. ⋯ This study reveals a surprisingly poor knowledge of high-risk body fluids and action to be taken following needlestick injury. Timely post-exposure prophylaxis, after needlestick exposure to high-risk body fluids, is believed to reduce the risk of seroconversion to HIV. Ignorance of this may increase the risk of seroconversion to HIV for anaesthetists and other healthcare professionals.