British journal of anaesthesia
-
The Minto remifentanil pharmacokinetic/pharmacodynamic (PK/PD) model is used in target-controlled infusion (TCI) devices. The endpoint used to calculate the PD parameters, including the ke0, was the electroencephalogram (EEG), which only changes at high remifentanil concentrations. As the ke0 should adequately predict the time course of drug effects at clinically relevant concentrations, we evaluated the temporal agreement between effect-site concentrations estimated with the Minto model and pressure pain thresholds during conscious sedation. ⋯ Our results demonstrate the limitation of the Minto PD model at low target remifentanil concentrations, with a discrepancy in the time course between EEG and pressure pain threshold changes. Clinicians should be aware that the time course of onset of analgesic effects is slower than the estimates of the Minto model. Investigators should consider using algometry data in future opioid PD modelling studies.
-
Reproductive health is an active area of practice and research for anaesthetists, intensivists, and pain medicine specialists. The purpose of the British Journal of Anaesthesia is to promote the health, welfare, and safety of all persons by disseminating knowledge to further our understanding of anaesthetic principles and improve practice and skills. This includes supporting safe abortion care as an integral part of safe reproductive health.
-
Editorial Comment
Changes in healthcare utilisation after surgical treatment: mitigating risk through multidisciplinary and collaborative care.
A recent study by Fowler and colleagues identified increased utilisation of healthcare resources among patients, mostly from deprived social areas with chronic diseases, undergoing emergency and high-risk surgery. Reasons for these findings include the intrinsic risk of surgery, postoperative complications, and the need for chronically ill patients to have their usual treatment resumed after surgery. To improve the overall outcome of surgery in this category of patients, a number of elements in the process of care should be adjusted. This includes minimising the number of emergency procedures and enhancing collaboration between all healthcare professionals inside and outside hospitals.