British journal of anaesthesia
-
Review Meta Analysis
Hypertension, hypertensive heart disease and perioperative cardiac risk.
The evidence for an association between hypertensive disease, elevated admission arterial pressure, and perioperative cardiac outcome is reviewed. A systematic review and meta-analysis of 30 observational studies demonstrated an odds ratio for the association between hypertensive disease and perioperative cardiac outcomes of 1.35 (1.17-1.56). This association is statistically but not clinically significant. ⋯ As a result, attention should be paid to the presence of target organ damage, such as coronary artery disease, and this should be taken into account in preoperative risk evaluation. The anaesthetist should be aware of the potential errors in arterial pressure measurements and the impact of white coat hypertension on them. A number of measurements of arterial pressure, obtained by competent staff (ideally nursing staff), may be required to obtain an estimate of the "true" preoperative arterial pressure.
-
Randomized Controlled Trial Clinical Trial
Supplementary oxygen for elective Caesarean section under spinal anaesthesia: useful in prolonged uterine incision-to-delivery interval?
The benefit of administering supplementary oxygen during elective Caesarean section under regional anaesthesia is controversial. It has been hypothesized that its use would improve fetal oxygenation in the event of a prolonged uterine incision-to-delivery (U-D) interval. Our aim was to test this hypothesis in a prospective, randomized, double-blinded, controlled study. ⋯ Supplementary oxygen did not increase fetal oxygenation in cases where the U-D interval was prolonged. Our data do not support the routine administration of supplementary oxygen during elective Caesarean section for this purpose.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Agitation and changes of Bispectral Index and electroencephalographic-derived variables during sevoflurane induction in children: clonidine premedication reduces agitation compared with midazolam.
This double-blind randomized study was undertaken to assess agitation, Bispectral Index (BIS) and EEG changes during induction of anaesthesia with sevoflurane in children premedicated with midazolam or clonidine. ⋯ Compared with midazolam, clonidine premedication reduced agitation during sevoflurane induction. During induction with sevoflurane 8% (oxygen 50%-nitrous oxide 50%), the nadir of the BIS occurred at the end of the second minute of inhalation. Agitation was associated with a more pronounced slowing of the EEG rhythms at BIS(nadir) compared with inductions in which no agitation was observed. The BIS may not follow the depth of anaesthesia during sevoflurane induction in children.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effect of rofecoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac.
Non-selective cyclooxygenase (COX) inhibitors or non-steroidal anti- inflammatory drugs (NSAIDs) are frequently omitted for perioperative pain relief because of potential side-effects. COX-2-selective inhibitors may have a more favourable side-effect profile. This study tested the hypothesis that the COX-2-selective inhibitor rofecoxib has less influence on platelet function than the NSAID diclofenac in gynaecological surgery. In addition, analgesic efficacy and side-effects of the two drugs were compared. ⋯ Besides having a smaller effect on platelet aggregation, one oral dose of rofecoxib 50 mg given before surgery provided postoperative analgesia similar to that given by three doses of diclofenac 50 mg and was associated with less use of anti-emetics and less surgical blood loss in gynaecological surgery compared with diclofenac.
-
Randomized Controlled Trial Clinical Trial
Randomized, controlled trial of the double setup tracheal tube during fibreoptic orotracheal intubation under general anaesthesia.
Impingement of the tracheal tube (ETT) on upper airway structures during railroading over the fibreoptic bronchoscope (FOB) occurs commonly. Potential complications of impingement include prolonged intubation time, leading to arterial desaturation, failed intubation and laryngeal trauma. The objective of this randomized, controlled trial was to assess the effect of the double setup ETT (a paediatric ETT is placed inside an adult ETT) on the incidence of impingement during orotracheal fibreoptic intubation. ⋯ The double setup ETT is effective in reducing ETT impingement and in reducing intubation time. We did not find an association between ETT impingement and arterial desaturation.