British journal of anaesthesia
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Selenium plays an important role in defence against acute illness. We investigated, in intensive care unit (ICU) patients, the time course of plasma selenium concentrations and their relationship to systemic inflammatory response syndrome (SIRS), organ dysfunction/failure, infection, and ICU outcome. ⋯ In critically ill surgical patients, plasma selenium concentrations are generally low with a greater decrease during the ICU stay in patients with organ failure, especially when attributed to infection. Lower plasma selenium concentrations are associated with more tissue damage, the presence of infection or organ dysfunction/failure, and increased ICU mortality.
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Randomized Controlled Trial Multicenter Study
Iontophoretic transdermal system using fentanyl compared with patient-controlled intravenous analgesia using morphine for postoperative pain management.
The fentanyl iontophoretic transdermal system (fentanyl ITS) enables needle-free, patient-controlled analgesia for postoperative pain management. This study compared the efficacy, safety, and ease of care of fentanyl ITS with patient-controlled, i.v. analgesia (PCIA) with morphine for postoperative pain management. ⋯ Fentanyl ITS and morphine PCIA were comparably effective and safe.
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Randomized Controlled Trial
Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section.
Spinal anaesthesia with bupivacaine combined with sufentanil has been widely used for Caesarean section. However, the main site of action (spinal vs central) of intrathecal (IT) sufentanil is controversial. The aim of this study was to examine the predominant mechanism of action of IT, small-dose sufentanil when added to bupivacaine for Caesarean section, by comparing the effects of IT and i.v. sufentanil 2.5 microg on the median effective dose (ED50) of bupivacaine. ⋯ Compared with an equal dose of sufentanil i.v., intrathecally administered sufentanil 2.5 microg has a significant local anaesthetic-sparing effect via a predominantly spinal mechanism for Caesarean section.
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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.
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Facial electromyography (FEMG) may have utility in the assessment of nociception during surgery. The difference between state entropy (SE) and response entropy (RE) is an indirect measure of FEMG. This study assesses an automated algorithm for remifentanil administration that is based on maintaining an entropy difference (ED) that is less than an upper boundary condition and greater than a lower boundary condition. ⋯ This feasibility study supports the concept that remifentanil may be delivered using an algorithm that maintains the difference between SE and RE between the upper and lower boundary condition.