British journal of anaesthesia
-
Randomized Controlled Trial Comparative Study
Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block.
Capacity to ambulate represents an important milestone in the recovery process after total knee arthroplasty (TKA). The purpose of this study was to determine the analgesic effect of two analgesic techniques and their impact on functional walking capacity as a measure of surgical recovery. ⋯ Femoral block is associated with lower opioid consumption and a better recovery at 6 weeks than periarticular infiltration. Early postoperative activity measures (2MWT and walking time) were proved to be possible indicators of knee function recovery at 6 weeks after surgery.
-
Randomized Controlled Trial
Intraoperative high-dose remifentanil increases post-anaesthetic shivering.
Remifentanil is associated with increased incidence of post-anaesthetic shivering (PAS). The aim of this study was to compare the effects of intraoperative high and low doses of remifentanil on PAS. ⋯ Remifentanil-induced PAS is not a phenomenon of intraoperative hypothermia. The higher incidence of PAS with higher doses of remifentanil probably reflects acute opioid tolerance and stimulation of N-methyl-d-aspartate receptors, similar to hyperalgesia. We conclude that patients administered high doses of remifentanil are sensitive to shivering after sudden drug withdrawal.
-
The endocannabinoid system (ECS) is an endogenous signalling system which includes the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) and specific G-protein-coupled endocannabinoid receptors (CB1 and CB2). Recent studies have described important roles of the peripheral ECS in human atherosclerosis, cardiometabolic disorders, heart failure, and systemic inflammation. We sought to study changes in plasma endocannabinoid concentrations during cardiac surgery (CS) under general anaesthesia with isoflurane/sufentanil, and during cardiopulmonary bypass (CPB). ⋯ General anaesthesia with isoflurane significantly reduces plasma AEA concentrations. This could be a consequence of stress reduction after loss of consciousness. The significant increase in 2-AG after initiation of CPB may be part of an inflammatory response. These findings suggest that anaesthesia and surgery have differential effects on the ECS which could have substantial clinical consequences.
-
Comparative Study
Size of internal jugular vs subclavian vein in small infants: an observational, anatomical evaluation with ultrasound.
The primary goal of this study was to compare the size and depth of the internal jugular vein (IJV) and the subclavian vein (SCV) in infants under general anaesthesia. A secondary goal was to determine the correlation of weight, height, head circumference, and age to the size and depth of these veins. ⋯ Because of its most likely larger size, the IJV can be recommended as the better choice for cannulation in comparison with the SCV. However, other factors should also be considered.
-
The LMA-Supreme (SLMA) is a single-use, latex-free, supraglottic airway device with a drain tube which allows immediate assessment of correct positioning of the device at insertion and throughout the procedure and provides access to gastric contents. The anatomically shaped airway tube facilitates easy insertion in anaesthetized patients in the supine, lateral, and prone positions. We present a prospective audit in 205 consecutive adult patients presenting for elective spine surgery in the prone position. Patients positioned themselves in the prone position, on a Montreal or Wilson mattress to optimize patient comfort in this position. Anaesthesia was then induced, and an appropriate-sized SLMA was inserted. ⋯ The results suggest that the SLMA is a useful device for airway management in patients anaesthetized in the prone position and for subsequent airway management with PPV, with or without neuromuscular block.