British journal of anaesthesia
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Prediction of movement responses to noxious stimuli during anaesthesia is of clinical importance. Susceptibility of a parameter of immobility to both hypnotic and analgesic influences could pose an advantage. Here, nociceptive reflexes might be useful, but data regarding the suppression by hypnotic substances are scarce. Therefore, we compared the prediction of movement responses by the RIII reflex threshold and the bispectral index (BIS) during propofol mono-anaesthesia. ⋯ Movement responses to noxious stimuli under propofol can be predicted by the RIII threshold with a comparable accuracy as the BIS. Therefore, the RIII threshold seems to be influenced by hypnotic effects. Since susceptibility of the RIII threshold to analgesic influences is well established, an advantage for the RIII threshold in the prediction of motor responses could be expected when analgesic substances are used in addition to propofol.
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Randomized Controlled Trial Comparative Study
Comparative study of topical anaesthesia with lidocaine 2% vs levobupivacaine 0.75% in cataract surgery.
This study compared the efficacy of topical anaesthesia with levobupivacaine 0.75% vs lidocaine 2% during cataract surgery by phacoemulsification. ⋯ Topical anaesthesia with levobupivacaine 0.75% was more effective than lidocaine 2% in preventing pain and improving patient and surgeon comfort during cataract surgery, with similar toxicity.
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Cyclic redistribution of air within the cuff during respiratory pressure changes creates a self-sealing mechanism which allows tracheal sealing, despite tracheal airway pressure being above baseline cuff inflation pressure. The aim of the present study was to investigate the effect of continuous automated cuff pressure regulation on tracheal sealing during cyclic respiratory pressure changes. ⋯ Automated cuff pressure controllers with rapid pressure correction interfere with the self-sealing mechanism of high sealing HVLP tube cuffs and reduce their improved sealing characteristics.
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Review Meta Analysis
Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials.
Intrathecal morphine without local anaesthetic is often added to a general anaesthetic to prevent pain after major surgery. Quantification of benefit and harm and assessment of dose-response are needed. We performed a meta-analysis of randomized trials testing intrathecal morphine alone (without local anaesthetic) in adults undergoing major surgery under general anaesthesia. ⋯ In conclusion, intrathecal morphine decreases pain intensity at rest and on movement up to 24 h after major surgery. Morphine-sparing is more pronounced after abdominal than after cardiac-thoracic surgery. Respiratory depression remains a major safety concern.