British journal of anaesthesia
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Review Meta Analysis
Opioid-induced respiratory depression in paediatrics: a review of case reports.
Opioids remain the cornerstone of modern-day pain treatment, also in the paediatric population. Opioid treatment is potentially life-threatening, although there are no numbers available on the incidence of opioid-induced respiratory depression (OIRD) in paediatrics. To get an indication of specific patterns in the development/causes of OIRD, we searched PubMed (May 2012) for all available case reports on OIRD in paediatrics, including patients 12 yr of age or younger who developed OIRD from an opioid given to them for a medical indication or due to transfer of an opioid from their mother in the perinatal setting, requiring naloxone, tracheal intubation, and/or resuscitation. ⋯ In eight cases, OIRD was due to an iatrogenic overdose. Three distinct patterns in the remaining data set specifically related to OIRD include: (i) morphine administration in patients with renal impairment, causing accumulation of the active metabolite of morphine; (ii) codeine use in patients with CYP2D6 gene polymorphism associated with the ultra-rapid metabolizer phenotype, causing enhanced production of the morphine; and (iii) opioid use in patients after adenotonsillectomy for recurrent tonsillitis and/or obstructive sleep apnoea, where OIRD may be related to hypoxia-induced enhancement of OIRD. Despite the restrictions of this approach, our analysis does yield an important insight in the development of OIRD, with specific risk factors clearly present in the data.
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In patients receiving an infusion of norepinephrine, the relationship between the amplitude of the oximeter plethysmographic waveform and stroke volume may be variable and quality of the waveform might be reduced, compared with patients not receiving norepinephrine. We assessed the reliability of the pleth variability index (PVI), an automatic measurement of the respiratory variation of the plethysmographic waveform, for predicting fluid responsiveness in patients receiving norepinephrine infusions. ⋯ PVI was less reliable than PPV and SVV for predicting fluid responsiveness in critically ill patients receiving norepinephrine. In addition, PVI could not be measured in a significant proportion of patients. This suggests that PVI is not useful in patients receiving norepinephrine.
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Comparative Study
Left ventricular volume and ejection fraction assessment with transoesophageal echocardiography: 2D vs 3D imaging.
Developments in transducer technology have enabled the use of three-dimensional transoesophageal echocardiography (3D TOE) in the operating theatre. Transthoracic echocardiography (TTE) 3D left ventricular (LV) volumes and ejection fraction (EF) agree better with magnetic resonance imaging (MRI) measurements, with less intra- and inter-observer variability compared with 2D. This has not been validated with 3D TOE. The aim of this study was to assess the bias, limits of agreement, and reproducibility of 3D TOE and 2D TOE LV volumes and EF in cardiac surgical patients. ⋯ The intraoperative use of 3D TOE to estimate LV volumes and EF has small bias compared with 2D assessments, wide limits of agreement, and no clear advantages compared with standard 2D TOE imaging in terms of LV volume and EF assessment.
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Randomized Controlled Trial
Long-term quality of sleep after remifentanil-based anaesthesia: a randomized controlled trial.
Clinical and pre-clinical data agree that opioids disrupt sleep architecture. Recently, remifentanil has been suggested to cause possible long-term disturbances of sleep quality. This randomized controlled clinical trial was designed to substantiate or refute a possible long-term effect of remifentanil on the quality of sleep. ⋯ The intraoperative use of remifentanil in a general patient population does not significantly alter the quality of sleep in the postoperative period. However, it may result in a significant reduction in the quality of sleep in patients before operation considered good sleepers. These changes were not observed in the group of patients receiving fentanyl. The relevance of these findings in terms of patient recovery and quality-of-life warrants further investigation. Trial Registration. ACTRN12610000362099.
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Randomized Controlled Trial Comparative Study
Ultrasound visual image-guided vs Doppler auditory-assisted radial artery cannulation in infants and small children by non-expert anaesthesiologists: a randomized prospective study.
Cannulation of the radial artery in infants and small children can be challenging, even for the most experienced providers. Utilizing Doppler to aid in radial artery cannulation has been well described. Recent studies have demonstrated the efficacy of ultrasound (US) image-guided vascular access techniques in the paediatric population. The utility of these two techniques, when used by non-expert personnel, has not been studied. ⋯ US-guided radial arterial cannulation in infants and small children provided a greater chance for success at the first attempt compared with the Doppler-assisted technique.