British journal of anaesthesia
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Comparative Study
Monitoring of the responsiveness to noxious stimuli during anaesthesia with propofol and remifentanil by using RIII reflex threshold and bispectral index.
Movement responses are an important indicator of noxious perception in the unconscious state. To allow for a continual monitoring of the responsiveness to noxious stimuli during general anaesthesia, surrogate parameters are needed. Here we compare the performance of the bispectral index (BIS) and the RIII threshold in predicting reactions to noxious stimuli during anaesthesia with propofol and remifentanil. ⋯ RIII threshold and BIS are both influenced dose-dependently by remifentanil at those concentrations that suppress reactions to noxious stimuli. The susceptibility of the parameters to remifentanil concentration seems to be of a similar quality. Under different ratios of propofol and remifentanil concentrations, the RIII threshold correlates with non-responsiveness better than the BIS.
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Postoperative nausea and vomiting (PONV) is common and of concern to patients and clinicians. The effect of PONV can range from trivial and transient to major clinical importance, and it is unclear which of its characteristics lead to discomfort and distress. ⋯ The PONV Intensity Scale is a valid, reliable, and responsive measure of clinically important PONV.
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Randomized Controlled Trial
Effect of desflurane at less than 1 MAC on QT interval prolongation induced by tracheal intubation.
Desflurane at more than 1 minimum alveolar concentration (MAC) has been shown to prolong the QT interval, but it is unclear whether this is the case at lower concentrations. The aim of this study was to determine whether desflurane concentrations of <1 MAC affect tracheal intubation-induced prolongation of the QT interval. ⋯ The administration of desflurane at an inspiratory concentration of 1 MAC during manually controlled ventilation after anaesthesia induction with propofol did not affect tracheal intubation-induced QTc prolongation.
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Randomized Controlled Trial
Effect of increased body mass index and anaesthetic duration on recovery of protective airway reflexes after sevoflurane vs desflurane.
Increased BMI may increase the body's capacity to store potent inhaled anaesthetics, more so with more soluble agents. Accordingly, we asked whether increased BMI and longer anaesthesia prolonged airway reflex recovery. ⋯ Prolonged sevoflurane administration and greater BMI delay airway reflex recovery. The contribution of BMI to this delay is more pronounced after sevoflurane than desflurane.
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The safety of epidural anaesthesia in patients at risk for right ventricular pressure overload remains controversial. We compared the haemodynamic effects of vascular and cardiac autonomic nerve block, induced by selective lumbar (LEA) and high thoracic epidural anaesthesia (TEA), respectively, in an animal model subjected to controlled acute right ventricular pressure overload. ⋯ In contrast to LEA, TEA reduced the haemodynamic tolerance to PA balloon occlusion by inhibiting the right ventricular positive inotropic response to acute pressure overload.