British journal of anaesthesia
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Intraoperative monitoring of the spinal cord via cortical somatosensory-evoked potentials (SSEP) is a routine during spinal surgery. However, especially in neuromuscular scoliosis, the reliability of cortical SSEP has been questioned. Therefore, we compared the feasibility of cortical SSEP in idiopathic and neuromuscular scoliosis using anaesthetics known to have only minimal effect on SSEP recordings. ⋯ Assessment of cortical SSEP during spine surgery was equally effective and reliable in patients with neuromuscular scoliosis and in patients with idiopathic scoliosis, possibly as a result of propofol-remifentanil anaesthesia.
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Review Meta Analysis
Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis.
We conducted a meta-analysis to examine the effect of intraoperative monitoring of neuromuscular function on the incidence of postoperative residual curarisation (PORC). PORC has been considered present when a patient has a train-of-four (TOF) ratio of < 0.7 or < 0.9. We analysed data from 24 trials (3375 patients) that were published between 1979 and 2005. ⋯ A simple peripheral nerve stimulator was used in 543 patients, and an objective monitor was used in 280. The incidence of PORC was found to be significantly lower after the use of intermediate neuromuscular blocking drugs. We could not demonstrate that the use of an intraoperative neuromuscular function monitor decreased the incidence of PORC.
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Little information is available regarding the neuromuscular effects of sevoflurane in patients with myasthenia gravis (MG). We evaluated the neuromuscular effects of sevoflurane alone in patients with MG and in those with normal neuromuscular transmission. ⋯ During sevoflurane anaesthesia, concentration-dependent inhibition of neuromuscular transmission was observed in MG and control patients. The inhibitory effects of sevoflurane were more prominent in MG patients with baseline T4/T1 <0.90.
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Randomized Controlled Trial Comparative Study
Randomized, double-blind comparison of patient-controlled epidural infusion vs nurse-administered epidural infusion for postoperative analgesia in patients undergoing colonic resection.
There is little published evidence of the analgesic efficacy of patient-controlled epidural analgesia (PCEA) for postoperative pain relief. The aim of this study was to compare the analgesic efficacy of epidural infusion of bupivacaine 0.125% and fentanyl 4 microg ml(-1) administered by either PCEA with a background infusion or nurse-administered continuous epidural infusion (CEI) after major intra-abdominal surgery. ⋯ PCEA provides greater analgesic efficacy than CEI for postoperative analgesia after major intra-abdominal surgery, and a decreased requirement for physician or nurse intervention.
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Randomized Controlled Trial
The coiling length of thoracic epidural catheters: the influence of epidural approach angle.
Thoracic epidural catheters are used for anaesthesia and postoperative analgesia. Usually, epidural catheters are placed without confirmation of their position despite frequent reports of complications as a result of malposition. In this study, we evaluated the threading length of thoracic epidural catheters without coiling and assessed the influence of two different epidural approach angles on the threading length without coiling. ⋯ Approaching the thoracic epidural space with an obtuse approach angle provides longer coiling length. We recommend that an obtuse approach angle should be used to maximize the chance of the catheter reaching the intended level with minimum risk of coiling.