British journal of anaesthesia
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There is an increasing trend towards performing craniotomy awake. The challenge for the anaesthetist is to provide adequate analgesia and sedation, haemodynamic stability, and a safe airway, with an awake, cooperative patient for neurological testing. ⋯ We have developed a technique for craniotomy, which facilitates awake neurological testing, is safe, and has good patient satisfaction.
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Comparative Study
Target controlled infusion of rocuronium: analysis of effect data to select a pharmacokinetic model.
We aimed to evaluate whether area under the curve (AUC) analysis of pharmacodynamic data can be used to compare pharmacokinetic models taken from the literature, during a target controlled infusion (TCI) of rocuronium. ⋯ It was possible to use AUC analysis for identification of the pharmacokinetic model that best predicted the pharmacodynamic characteristics of our patients.
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Randomized Controlled Trial Clinical Trial
Plasma propofol concentration and EEG burst suppression ratio during normothermic cardiopulmonary bypass.
During cardiopulmonary bypass (CPB), several factors affect drug disposition and action. This topic has not been studied extensively during normothermic CPB. In this study, we related propofol dose to plasma propofol concentration and burst suppression of the EEG during normothermic bypass. ⋯ The pharmacokinetics and pharmacodynamics of propofol change during normothermic CPB. During normothermic CPB, the efficacy of propofol may be enhanced compared with before CPB.
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The depth of insertion of the ProSeal laryngeal mask airway (PLMA) is unknown. We measured depth of insertion in satisfactorily positioned PLMAs. ⋯ Usually most of the integral bite block lies within the oropharynx. It was never normal for the entire bite block to stick out of the mouth (4 SD from the mean for both men and women). The position of the integral bite block relative to the upper incisors gives valuable information during assessment of PLMA position.
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Ketamine is used as an anaesthetic agent for short surgical procedures, and as a sedative and analgesic in intensive care patients. Intensive care patients with brain or spinal cord injury may have physiological changes that could alter the pharmacokinetics of ketamine. The pharmacokinetics of ketamine have been studied in healthy volunteers and in patients undergoing different types of surgery, but no data are available in intensive care patients. ⋯ Pharmacokinetic variables of ketamine in intensive care patients are greater than in healthy volunteers and in surgical patients. The increase in the volume of distribution is greater than the increase in clearance, resulting in a longer estimated half-life of ketamine in this patient group.