British journal of anaesthesia
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Randomized Controlled Trial
Simulation as a set-up for technical proficiency: can a virtual warm-up improve live fibre-optic intubation?
Fibre-optic intubation (FOI) is an advanced technical skill, which anaesthesia residents must frequently perform under pressure. In surgical subspecialties, a virtual 'warm-up' has been used to prime a practitioner's skill set immediately before performance of challenging procedures. This study examined whether a virtual warm-up improved the performance of elective live patient FOI by anaesthesia residents. ⋯ Virtual warm-up significantly improved performance by residents of FOI in live patients with normal airway anatomy, as measured both by speed and by a scaled evaluation of skills.
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Observational Study
Emergence delirium or pain after anaesthesia-how to distinguish between the two in young children: a retrospective analysis of observational studies.
Early postoperative negative behaviour in preschool children after general anaesthesia is a common problem. The distinction between emergence delirium (ED) and pain is difficult, but management differs between the two. The aim of the current analysis was to identify individual observational variables that can be used to diagnose ED and allow distinction from postoperative pain. ⋯ 'No eye contact' and 'no awareness of surroundings' identifies ED. 'Abnormal facial expression', 'crying', and 'inconsolability' indicate acute pain in children in the early postoperative period.
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Randomized Controlled Trial Comparative Study
Comparison of tissue distribution, phrenic nerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: a randomized, controlled trial†.
Ultrasound guidance allows for the use of much lower volumes of local anaesthetics for nerve blocks, which may be associated with less aberrant spread and fewer complications. This randomized, controlled study used contrast magnetic resonance imaging to view the differential-volume local anaesthetic distribution, and compared analgesic efficacy and respiratory impairment. ⋯ This study was registered with the European Medicines Agency (Eudra-CT number 2013-004219-36) and with the US National Institutes' of Health registry and results base, clinicaltrials.gov (identifier NCT02175069).
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While it is well known that opioids depress the immune system, the site(s) of action for this depression is highly controversial. Immune modulation could occur directly at the immune cell or centrally via the hypothalamic-pituitary-adrenal axis. In a number of studies using individual enriched immune cell populations we have failed to detect classical µ (MOP), δ (DOP) and κ (KOP) receptors. The non-classical nociceptin/orphanin FQ (N/OFQ) receptor (NOP) is expressed on all cells examined thus far. Our hypothesis was that immune cells do not express classical opioid receptors and that using whole blood would definitively answer this question. ⋯ Classical opioid receptors are not expressed on circulating immune cells.