British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect-site concentration: Performance of three pharmacokinetic-dynamic models.
In the ideal pharmacokinetic-dynamic (PK-PD) model for calculating the predicted effect-site concentration of propofol (Ce(PROP)), for any Ce(PROP), the corresponding hypnotic effect should be constant. We compared three PK-PD models (Marsh PK with Shüttler PD, Schnider PK with fixed ke0, and Schnider PK with Minto PD) in their ability to maintain a constant bispectral index (BIS), while using the respective effect-site-controlled target-controlled infusion (TCI) algorithms. ⋯ Targeting Ce(PROP) at which patients lose consciousness with effect-site-controlled TCI does not translate into an immediate constant effect.
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Local anaesthetics exhibit direct neurotoxic effects on neurones. Numerous studies have investigated the factors that may reverse this neuropathology, but the effects of glucose conditions on neuronal regeneration after lidocaine-induced injury have not been examined by observing living neurones. The present study investigated the effects of different glucose conditions on neurite length, growth cone regeneration, and cell death in dorsal root ganglia (DRG) neurones after lidocaine-induced injury in vitro. ⋯ Normal glucose is optimal for neuronal recovery after lidocaine-induced injury in vitro.
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Letter Case Reports
Effect of decompressive craniectomy on bispectral index and memory.
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Performance assessment is becoming increasingly necessary in the medical workplace. Hospitals and patients expect safety, and under-performance by a doctor can compromise standards. By describing and quantifying performance, positive behaviour can be encouraged and unsafe behaviour remedied. Anaesthesia Non-Technical Skills (ANTS) is a behavioural marker system that can be used to assess non-technical skills in the workplace. ⋯ Anaesthetists could not be trained to reliably use ANTS as a summative assessment tool using our 1 day programme. There was an inadequate correlation of scores between participants and experts. Two major problems contributed to the lack of agreement. Observed behaviours were often misclassified into the incorrect element and safety beliefs varied among anaesthetists. Other reasons for the failure to achieve success and potential future direction are discussed.
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In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy. ⋯ The benefit of adding ketamine to morphine in i.v. PCA for orthopaedic or abdominal surgery remains unclear. Owing to huge heterogeneity of studies and small sample sizes, larger double-blinded randomized studies showing greater degree of homogeneity are required to confirm these findings.