British journal of anaesthesia
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Editorial Comment
Phase-amplitude coupling during maintenance of general anaesthesia: towards a better understanding of anaesthetic-induced brain dynamics in children.
Electroencephalogram signatures associated with anaesthetic-induced loss of consciousness have been widely described in adult populations. A recent study helps verify our understanding of brain dynamics induced by anaesthetics in a paediatric population by describing a specific pattern in terms of an interaction of the phase of delta oscillations and the amplitude of alpha oscillations. This feature has potential translational implications for optimising future monitoring technologies.
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Over the past century, education has been a core component for improving patient safety. The initial focus was developing a curriculum and an assessment process. ⋯ Conceptions of feedback have moved from a transactional information transfer from the supervisor to the trainee to a learner-centred and collaborative process occurring in a complex socio-cultural environment. In this narrative review we describe the evolution of the feedback conversation, provide a model synthesising the core concepts of feedback, and offer some guidance for the development of effective feedback in anaesthesia education.
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Preventing postoperative organ dysfunction is integral to the practice of anaesthesia. Although intraoperative hypotension is associated with postoperative end organ dysfunction, there remains ambiguity with regards to its definition, targets, thresholds for initiating treatment, and ideal treatment modalities.
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The need to introduce guidelines on neuromuscular monitoring emphasising the use of quantitative techniques that record the train-of-four ratio is now recognised by an increasing number of national anaesthetic societies in the Western world. But the challenge of convincing individual anaesthetists to adopt and use this practice routinely remains. For >10 yr, it has been recognised that all staff in anaesthetic departments need to have regular training in modern neuromuscular monitoring techniques. We discuss a publication in this journal that describes the challenges of setting up multicentre training in Spain to expand the use of quantitative neuromuscular monitoring and their short-term results.
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Major cardiac surgery related blood loss is associated with increased postoperative morbidity and mortality. Platelet dysfunction is believed to contribute to post-cardiopulmonary bypass (CPB)-induced microvascular bleeding. We hypothesised that moderately hypothermic CPB induces platelet dysfunction and that supplemental fibrinogen can restore in vitro thrombus formation. ⋯ Single valve surgery using moderately hypothermic CPB induces partial platelet dysfunction. Thrombus formation was restored in an experimental study design by ex vivo supplementation of fibrinogen.