British journal of anaesthesia
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In recent decades, a number of studies have attempted to determine whether regional anaesthesia offers convincing benefits over general anaesthesia. However, today we interpret meta-analyses more carefully, and it remains unclear whether regional anaesthesia reduces mortality. ⋯ Recent developments in technical aspects of regional anaesthesia have the potential to provide significant advantages for many patients in all age groups. Moreover, studies focusing on specific outcomes have shown benefits for regional anaesthesia used for surgery and postoperative analgesia.
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The incidence of chronic pain after hysterectomy is reported to be up to 30%, but the relative role of different pathogenic factors has not been defined. This study aimed to assess the predictive value of preoperative abdominal and vaginal mechanosensitivity for the subsequent development of acute and chronic pain after hysterectomy. ⋯ Preoperative pain sensitization as reflected by cutaneous and vaginal hypersensitivity is associated with acute pain after hysterectomy, but less so with persistent pain.
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Paradoxical excitement response during sedation consists of loss of affective control and abnormal movements. Chronic alcohol abuse has been proposed as a predisposing factor despite lack of supporting evidence. Because alcohol and propofol have a common site of action, we postulated that paradoxical excitement responses during propofol-induced sedation occur more frequently in hazardous and harmful alcohol drinkers than in social or non-drinkers. ⋯ Paradoxical excitement occurred more frequently and severely in hazardous and harmful alcohol drinkers than in social drinkers during propofol-induced moderate-to-deep sedation, but not during light sedation.
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Acute kidney injury (AKI) is common after cardiac surgery, affecting outcome. Early detection of an AKI marker is likely to speed diagnosis and implementation of measures to preserve renal function. In septic shock and unselected ventilated subjects, an increased Doppler renal resistive index (RRI) is a predictor of AKI. This study aims to determine whether RRI would act similarly in the postoperative setting of cardiac surgery. ⋯ RRI used in the immediate POP after cardiac surgery with CPB enabled prediction of delayed AKI and anticipation of its severity.
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Central noradrenergic neurones have a role in alertness, analgesia, and thermoregulation; these neurones are also involved in the mechanism of anaesthesia. Locus coeruleus neurones innervate various central nervous regions including the cerebral cortex and hippocampus, and are responsible for wakefulness and analgesia. We hypothesized that these neurones are also involved in both activation of the γ-aminobutyric acid type A (GABA(A)) receptor and inhibition of N-methyl-d-aspartate (NMDA) receptor-mediated anaesthesia. ⋯ The present data indicate that coerulean noradrenergic neurones may be responsible for both GABA- and NMDA-mediated anaesthetic actions.