British journal of anaesthesia
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Randomized Controlled Trial
Morphine and hydromorphone pharmacokinetics in human volunteers: population-based modelling of interindividual and opioid-related variability.
Morphine and hydromorphone have differing onsets, magnitudes, and durations of effects and side-effects. Differences between opioids in their interindividual variabilities in pharmacokinetics and pharmacodynamics might influence rational drug selection. Crossover drug studies can provide more informative interindividual variability data than parallel group studies. Using data from a crossover study of i.v. morphine and hydromorphone in healthy volunteers, we tested the hypothesis that morphine and hydromorphone differ in their interindividual pharmacokinetic variability. ⋯ Morphine and hydromorphone did not differ in a statistically significant or clinically meaningful manner in their interindividual pharmacokinetic variability. Interindividual pharmacokinetic variability does not appear a meaningful consideration in the choice between these two opioids.
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Observational Study
Residual neuromuscular block in the postanaesthesia care unit: a single-centre prospective observational study and systematic review.
Concerns regarding residual neuromuscular block (RNMB) have persisted since the introduction of neuromuscular blocking agents, with reported incidences in the 21st century up to 50%. Advances in neuromuscular transmission (NMT) monitoring and the introduction of sugammadex have addressed this issue, but the impact of these developments remains unclear. ⋯ The incidence of residual neuromuscular block in the PACU was 2.2%. This suggests significant improvement in the prevention of residual neuromuscular block and stresses the importance of rigorous neuromuscular transmission monitoring and adequate use of reversal agents.
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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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Aperiodic (nonoscillatory) electroencephalogram (EEG) activity can be characterised by its power spectral density, which decays according to an inverse power law. Previous studies reported a shift in the spectral exponent α from consciousness to unconsciousness. We investigated the impact of aperiodic EEG activity on parameters used for anaesthesia monitoring to test the hypothesis that aperiodic EEG activity carries information about the hypnotic component of general anaesthesia. ⋯ Aperiodic EEG activity could improve discrimination between consciousness and unconsciousness using spectral analyses.
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Editorial Letter
NAP7: high mortality risk in neonates and very low risk in children.
Editor-We congratulate Lyne and colleagues1 on their initiative to explore and improve consent around perioperative mortality in children. Providing such data for families and clinicians is a key purpose of the Royal College of Anaesthetists' National Audit Projects (NAPs), and to this end, NAP7 studied perioperative cardiac arrest.2-4.