British journal of anaesthesia
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Randomized Controlled Trial
Liberal fluid fasting: impact on gastric pH and residual volume in healthy children undergoing general anaesthesia for elective surgery.
The paediatric preoperative fasting time of 2 h for clear fluids, as suggested by guidelines, is often exceeded. Shorter preoperative fasting has been proposed to avoid potential outcomes such as dehydration, ketoacidosis, reduced arterial blood pressure, and patient discomfort. The aim of this study was to investigate whether liberal clear fluid intake until premedication significantly reduces actual fasting time and impacts gastric pH and residual volume. ⋯ NCT02603094.
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Randomized Controlled Trial
Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia.
Preoperative fasting is a major cause of perioperative discomfort in paediatric anaesthesia and leads to postoperative insulin resistance, thus potentially enhancing the inflammatory response to surgery. Addressing these problems by preoperative carbohydrate intake has not been a well-defined approach in children. ⋯ DRKS00005020.
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Multicenter Study
Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females.
Conditioned pain modulation is a potential biomarker for risk of persistent pain. As early-life experience can alter subsequent somatosensory processing and pain response, we evaluated conditioned pain modulation after extremely preterm birth. ⋯ Cold conditioning evoked inhibitory modulation in the majority of young adults and identified a subgroup of extremely preterm females with increased baseline sensitivity. Early-life experience and sex/gender should be considered when evaluating persistent pain risk with conditioned pain modulation.
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Maintaining situation awareness of monitored patients can be challenging because care providers must continually read and integrate multiple waveforms and numerical vital sign values into a mental model of the patient's situation. We developed and evaluated a technology designed to improve perception of vital sign information by presenting patient status as an animated patient avatar. ⋯ This study provides empirical evidence that an animated avatar offers the opportunity to transmit vital sign information significantly more quickly than conventional monitoring and with improved confidence and reduced cognitive effort. This could help care providers gain situation awareness more efficiently.
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Near-infrared spectroscopy, a non-invasive technique for monitoring cerebral oxygenation, is widely used, but its accuracy is questioned because of the possibility of extra-cranial contamination. Ultrasound-tagged near-infrared spectroscopy (UT-NIRS) has been proposed as an improvement over previous methods. We investigated UT-NIRS in healthy volunteers and in brain-dead patients. ⋯ In brain-dead patients, where CBF is absent, the UT-NIRS findings can indicate an apparently perfused brain. This might reflect an insufficient separation of signals from extra-cranial structures from a genuine appraisal of cerebral perfusion. For non-invasive assessment of CBF-related parameters, the near-infrared spectroscopy still needs substantial improvement.