British journal of anaesthesia
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Studies have shown that local use of volatile anaesthetics produce local anaesthetic effects such as local infiltration anaesthesia (in rats and humans) and spinal anaesthesia (in dogs). However, there is still no report on the epidural anaesthetic effect of volatile anaesthetics. The aim of the present study was to evaluate the epidural anaesthetic effect of the 8% emulsified isoflurane in rabbits. ⋯ The present study demonstrates that epidural administration of the 8% emulsified isoflurane produces completely a reversible epidural anaesthetic effect that does not affect the level of consciousness in rabbits.
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Multicenter Study
National survey of College Tutors in the UK regarding training in medical education.
College Tutors are responsible for the organization of training and should possess the pre-requisite knowledge and skills to facilitate this. ⋯ This survey highlights that training in medical education for College Tutors is inadequate. It is the responsibility of the Colleges and the Postgraduate Deans to ensure College Tutors are supported appropriately to develop the knowledge and skills required for the role.
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Randomized Controlled Trial
Transcutaneous electrical nerve stimulation at the PC-5 and PC-6 acupoints reduced the severity of hypotension after spinal anaesthesia in patients undergoing Caesarean section.
Despite prophylactic measures, hypotension remains a common side-effect of spinal anaesthesia for parturients. Electroacupuncture at the Neiguan (PC-6) and Jianshi (PC-5) points influences haemodynamics. We thus hypothesized that transcutaneous electrical nerve stimulation (TENS) at traditionally used acupuncture points would reduce the severity of hypotension after spinal anaesthesia in patients undergoing Caesarean section. ⋯ TENS on the traditional acupuncture points reduced the severity and incidence of hypotension after spinal anaesthesia in parturients.
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The relationship between measures of drug effect such as bispectral index (BIS) and end-tidal (ET) levels of anaesthetic agents is described by the 'effect site equilibrium half-time', t(1/2)(ke0). There are limited data available on sevoflurane t(1/2)(ke0) during routine anaesthesia and surgery. Preliminary observations suggested t(1/2)(ke0) for the degree of hypnosis as estimated by BIS is different from that for burst suppression of the electroencephalograph, occurring at 'deep' levels of anaesthesia. This study aimed to determine and compare t(1/2)(ke0) for these two 'effects'. ⋯ The different values of t(1/2)(ke0) for these effects suggest different sites or mechanisms of action. These results also establish values of t(1/2)(ke0) which can be used to provide the real-time estimates of effect-site sevoflurane concentration in clinical practice.
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We tested the hypothesis that sodium nitroprusside (SNP) might improve the impairment of hepatosplanchnic microcirculatory blood flow (MBF) in septic shock. ⋯ In a resuscitated porcine model of the early phase of septic shock, SNP improved ileal mucosal MBF but required a concomitant increase in fluid and norepinephrine supplements to maintain constant systemic haemodynamic parameters.