British journal of anaesthesia
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Pholcodine consumption greatly increases the risk of NMBD anaphylaxis (OR 14.0).
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Randomized Controlled Trial Comparative Study
Lung recruitment in the prone position after cardiac surgery: a randomised controlled study.
Atelectasis after cardiac surgery is common and promotes ventilation/perfusion mismatch, infection, and delayed discharge from critical care. Recruitment manoeuvres are often performed to reduce atelectasis. In severe respiratory failure, recruitment manoeuvres in the prone position may increase oxygenation, survival, or both. We compared the effects of recruitment manoeuvres in the prone vs supine position on lung aeration and oxygenation in cardiac surgical patients. ⋯ NCT03009331.
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Comparative Study
Offline comparison of processed electroencephalogram monitors for anaesthetic-induced electroencephalogram changes in older adults.
Several devices record and interpret patient brain activity via electroencephalogram (EEG) to aid physician assessment of anaesthetic effect. Few studies have compared EEG monitors on data from the same patient. Here, we describe a set-up to simultaneously compare the performance of three processed EEG monitors using pre-recorded EEG signals from older surgical patients. ⋯ All monitors distinguished EEG changes occurring before anaesthesia administration and during LOR. The PSI and BIS best detected suppressed periods. Our results suggest that the PSI and BIS monitors might be preferable for older patients with risk factors for intraoperative awareness or increased sensitivity to anaesthesia.
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Observational Study
Cerebral autoregulation in the operating room and intensive care unit after cardiac surgery.
Cerebral autoregulation monitoring is a proposed method to monitor perfusion during cardiac surgery. However, limited data exist from the ICU as prior studies have focused on intraoperative measurements. Our objective was to characterise cerebral autoregulation during surgery and early ICU care, and as a secondary analysis to explore associations with delirium. ⋯ Metrics of cerebral autoregulation are altered in the ICU, and may be clinically relevant with respect to delirium. Further studies are needed to investigate these findings and determine possible benefits of autoregulation-based MAP targeting in the ICU.
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General anaesthesia is known to enhance inhibitory synaptic transmission to produce characteristic effects on the EEG and reduction in brain metabolism secondary to reduced neuronal activity. Evidence suggests that anaesthesia might have a direct effect on synaptic metabolic processes, and this relates to anaesthesia sensitivity. We explored elements of synaptic transmission looking for possible contributions to the anaesthetised EEG and how it may modulate anaesthesia sensitivity. ⋯ Our model suggests how metabolic processes can modulate anaesthesia and produce non-receptor dependent drug sensitivity.