British journal of anaesthesia
-
Randomized Controlled Trial
Influence of the anaesthetic depth on the inhibition of the oculocardiac reflex during sevoflurane anaesthesia for paediatric strabismus surgery.
It remains controversial whether the anaesthetic depth as assessed by bispectral index (BIS) influences the oculocardiac reflex (OCR) during strabismus surgery. We investigated whether BIS-guided sevoflurane titration may help to optimize the anaesthetic depth for inhibition of the OCR during paediatric strabismus surgery. ⋯ We confirmed that OCR is relevant to the depth of anaesthesia. BIS values of 40-50 seem adequate for the inhibition of OCR. The results suggest that BIS may be a valuable tool during sevoflurane anaesthesia for strabismus surgery in children.
-
There is a paucity of data regarding the coagulation status when discontinuing perineural catheters in patients receiving anticoagulant after operation. This retrospective study was designed to establish international normalized ratio (INR) and prothrombin time (PT) at the time of removal of lumbar plexus perineural catheters in patients receiving warfarin after total hip replacement. ⋯ Although in this retrospective analysis, we demonstrated that lumbar plexus catheters were removed with an INR > or =1.5, additional data are required to confirm the safety of such an approach.
-
In this study we analyse the behaviour, potential clinical application and optimal cortical sampling location of the spectral parameters: (i) relative alpha and beta power; (ii) spectral edge frequency 90%; and (iii) spectral entropy as monitors of moderate propofol-induced sedation. ⋯ Relative beta power and spectral entropy when considered over the propofol effect-site range studied here increase in value, and correlate well with clinical assessment of sedation.
-
The metabolism of the short-acting anaesthetic agent propofol has been described over the first 24 h. However, the long-term disposition of propofol and its metabolites is unclear. We describe the pharmacokinetics (renal excretion rates and renal clearance) of propofol and its metabolites over 60 h. ⋯ After an infusion of propofol, patients excrete propofol and its metabolites in the urine over a period in excess of 60 h. We hypothesize that (re)absorption of propofol and its metabolites by the kidney is a major process in elimination and that the reabsorbed compounds are gradually conjugated in the kidney and excreted in the urine. One patient showed a different pharmacokinetic profile for which we currently have no explanation.