British journal of anaesthesia
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Randomized Controlled Trial
Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity.
Choice of opioid may influence postoperative pain, recovery, and respiratory homeostasis in morbid obesity. The aim of this study was to compare the effects of target-controlled infusions (TCIs) of remifentanil or sufentanil on postoperative analgesia, recovery, and pulmonary function after laparoscopic gastric banding. ⋯ As few differences occurred in the postoperative period, the theoretical advantage of remifentanil over the longer acting sufentanil can be questioned when using TCI technology.
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The ProSeal laryngeal mask airway (PLMA), introduced to UK practice in late 2001, offers potential performance and safety benefits over other airways such as the classic laryngeal mask airway. There are no large series reporting its use. ⋯ In the hands of a regular user, the PLMA was associated with a high rate of insertion success during routine and advanced use in relatively unselected patients. Correct placement rates approached 100%. The incidence of complications was low.
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Comparative Study
Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis.
Recently, continuous monitoring of cardiac output (CO) based on pulse contour analysis (Vigileo) has been introduced into practice. In this clinical study, we evaluated the accuracy of this system by comparing it with the transpulmonary thermodilution technique (TPID) in septic patients. ⋯ Pulse contour analysis-derived CO (Vigileo system) underestimates CO(TPID) and is not as reliable as transpulmonary thermodilution in septic patients.
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The reticular and thalamocortical system is known to play a prominent role in spindle wave activity, and the spindle wave is related to the sedative effects of anaesthetics. Recently, bispectral analysis of the EEG has been developed as a better method to indicate nonlinear regulation including the thalamocortical system linking to the cortical area. In the present study, in order to explore the interference of ketamine with the nonlinear regulation of the sub-cortical system, we examined the effect of ketamine on spindle alpha waves through the bispectral analysis. ⋯ Ketamine shifted the alpha peaks of bicoherence induced by propofol to higher frequencies. This suggests that ketamine changes the alpha spindle rhythms through the modulation of the nonlinear sub-cortical reverberating network.