British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study
Ultrasonographic guidance for sciatic and femoral nerve blocks in children.
Recent studies have shown that ultrasound guidance for paediatric regional anaesthesia can improve the quality of upper extremity and neuraxial blocks. We therefore investigated whether ultrasound guidance for sciatic and femoral nerve blocks prolongs sensory blockade in comparison with nerve stimulator guidance in children. ⋯ Ultrasound guidance for sciatic and femoral nerve blocks in children increased the duration of sensory blockade in comparison with nerve stimulator guidance. Prolonged sensory blockade was achieved with smaller volumes of local anaesthetic when using ultrasound guidance.
-
Randomized Controlled Trial
Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia.
Hypnotic depth but not haemodynamic responsiveness is measured with EEG-based monitors. In this study we compared heart rate variability (HRV) in unstimulated patients and stimulation-induced HRV at different levels of anaesthesia. ⋯ HRV parameters discriminate between awake and general anaesthesia, are different after tracheal intubation and a 5 s ulnar nerve stimulation, but do not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia.
-
Comparative Study
Multi-level approach to anaesthetic effects produced by sevoflurane or propofol in humans: 2. BIS and tetanic stimulus-induced withdrawal reflex.
General anaesthesia could be assessed at two sites: cortical structures and the spinal cord. However, the practicalities of measurement at these two sites differ substantially. ⋯ High concentrations of sevoflurane depress TIWR more than propofol. With propofol, we frequently observed a paradoxical behaviour of muscles of the lower leg. TIWR lags behind BIS, indicating different effect sites for two intended anaesthetic effects: unresponsiveness to noxious stimulation and unconsciousness.
-
We describe the use of non-invasive positive pressure ventilation combined with spinal anaesthesia to allow the insertion of a dynamic hip screw in an obese patient with advanced chronic obstructive pulmonary disease. The technique avoided the hazards of intubation and general anaesthesia in this high-risk patient.