British journal of anaesthesia
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The dimensionless Narcotrend (NCT) index (MonitorTechnik, Germany, version 4.0), from 100 (awake) to 0, is a new index based on electroencephalogram pattern recognition. Transferring guidelines for titrating the Bispectral Index (BIS, Aspect Medical Systems, USA, version XP) to the NCT index depends on their comparability. We compared the relationship between BIS and NCT values during propofol anaesthesia. ⋯ We found a sufficient correlation between BIS and NCT index, but deviations from the line of identity in some ranges require attention. Therefore, a simple 1:1 transfer from BIS to NCT values is not adequate. Our results might serve as a blueprint for the rational translation of BIS into NCT values.
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Among the factors influencing the onset of action of neuromuscular blocking agents (NMBA), the potency (EC50) and the rate of equilibration between blood and the effect compartment (k(e0)) have been highlighted. Although these descriptors are intrinsically influenced by the physicochemical characteristics of the drug, the impact of lipid solubility, molecular weight and protein binding on pharmacokinetic-pharmacodynamic (PK-PD) descriptors has not been established for most NMBA. ⋯ The basic characteristics of NMBAs, namely, molecular weight, lipid solubility and protein binding, are strongly associated with the kinetics of the drug response.
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Case Reports
Use of recombinant factor VIIa to treat life-threatening non-surgical bleeding in a post-partum patient.
Ongoing bleeding from patients who have an acquired coagulopathy post-surgery is a common problem. Strategies that are available to combat this problem revolve around the replacement of coagulation factors, platelets, and red blood cells as necessary. These strategies are not always successful and a more direct approach to activating the coagulation system can be more effective and in some instances life saving. We describe the use of recombinant factor VIIa in a patient with ongoing post partum bleeding.
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Comparative Study
Differential effects of propofol, ketamine, and thiopental anaesthesia on the skeletal muscle microcirculation of normotensive and hypertensive rats in vivo.
This study utilized the dorsal microcirculatory chamber (DMC) model to determine differential effects of i.v. propofol, ketamine, and thiopental anaesthesia on the skeletal muscle microcirculation (10-180 micro m) of normotensive (Male Wistar Kyoto, WKY) and hypertensive (spontaneously hypertensive Harlan, SHR) rats, importantly, comparing responses to a conscious baseline. ⋯ Within the skeletal muscle microcirculation of hypertensive rats there is enhanced dilation with propofol and constriction with ketamine, associated with exaggerated changes in arterial pressure. Thus, dysfunctional control mechanisms at the level of the microcirculation alter responses to anaesthesia during hypertension.