British journal of anaesthesia
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Spinal cord stimulation (SCS) is widely accepted as a useful treatment for patients with intractable chronic pain. However, its effectiveness varies between individuals. Therefore, a tool for evaluating its effectiveness in advance is eagerly awaited. We examined whether resting-state functional magnetic resonance imaging as a diagnostic and prognostic tool can predict responsiveness to SCS. ⋯ For patients with intractable chronic pain, functional connectivity between the middle anterior cingulate cortex and precuneus/posterior cingulate cortex is a promising candidate biomarker to estimate responsiveness to spinal cord stimulation before treatment.
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Paediatric acute kidney injury (AKI) is common and linked to longer hospitalisation and mortality. We investigated whether a continuous intraoperative infusion of dexmedetomidine, which increases renal blood flow, was associated with a lower risk of postoperative AKI in paediatric patients undergoing noncardiac surgery. ⋯ ChiCTR2300069115.
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Postoperative mortality in Africa is twice that of wealthier countries. The SMARTER trial underscores this critical issue and aims to address the high mortality rates by harnessing a readily available resource requiring minimal funding. Conducted in Mbale, Uganda, this innovative trial trained family members to monitor basic vital signs following surgery. ⋯ Although the results demonstrate a potential for increasing the capacity to rescue in the postoperative period, there is a need for further research to assess real-world effectiveness. Any improvement in patient monitoring would be limited by the system's capacity to respond effectively to escalations made by family members and the possible inaccuracy of their monitoring. Intervening earlier in the preoperative pathway can reduce the need to rescue postoperatively, but the SMARTER intervention has the potential to contribute to the larger effort needed to reduce surgical deaths globally in resource-limited settings.
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Machine learning (ML) algorithms hold significant potential for extracting valuable clinical information from big data, surpassing the processing capabilities of the human brain. However, it would be naïve to believe that ML algorithms can consistently transform data into actionable insights. ⋯ Additionally, ML algorithms might not be necessary for analysing 'small data', such as a limited number of haemodynamic variables. In this respect, whether haemodynamic profiling with an ML algorithm offers advantages over straightforward classification tables or simple visual decision support tools remains unclear.
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The acute hypoxic ventilatory response is a critical chemoreflex originating at the carotid bodies. This study investigates the impact of low-dose i.v. esketamine on the ventilatory response to 20 min of isocapnic hypoxia to test the hypothesis that esketamine does not affect hypoxic ventilation. ⋯ The trial was registered at the ISRCTN registry on June 27, 2023 under identifier ISRCTN 42617929 (https://www.isrctn.com/ISRCTN42617929).