British journal of anaesthesia
-
Due to the growing importance of quality assurance and cost containment in healthcare, eliciting patients' preferences for post-operative outcomes may be a more economical and reliable method of assessing quality. Three hundred and fifty-five day surgery patients completed a pre-operative written questionnaire to identify patients' preferences for avoiding 10 particular post-operative symptoms: pain, nausea, vomiting, disorientation, shivering, sore throat, drowsiness, gagging on the tracheal tube, thirst and a normal outcome. ⋯ Avoiding post-operative pain, gagging on the tracheal tube and nausea and vomiting are major priorities for day-case patients. Anaesthetists should take patients' preferences into consideration when developing guidelines and planning anaesthetic care.
-
Comparative Study
Comparison of relaxant effects of propofol on methacholine-induced bronchoconstriction in dogs with and without vagotomy.
Propofol has been suggested to have in vivo airway relaxant effects, although the mechanism is still unclear. In this study, we determined whether propofol could antagonize methacholine-induced bronchoconstriction and determined whether vagotomy modifies this relaxant effect. Fourteen mongrel dogs anaesthetized with pentobarbital and pancuronium were assigned to a control group (n=7) and a vagotomy group (n=7). ⋯ The two groups did not differ significantly in the maximal inhibitory effect of propofol [control group, 61.1% (46.3-75.9%), vagotomy group, 64.2% (40.1-88.3%)] or pIC50 [control group 5.03 (4.55-5.51), vagotomy group 4.86 (4.49-5.24)]. Therefore, the relaxant effects of propofol on methacholine-induced bronchoconstriction may not be mediated centrally. Propofol may relax airway smooth muscles directly or through the peripheral vagal pathway.
-
Ischaemic preconditioning can protect the myocardium against ischaemic injury by opening of the adenosine triphosphate (ATP)-sensitive potassium (K(ATP)) channel. Isoflurane is also thought to open this channel. The present investigation tested the hypothesis that pre-ischaemic treatment with isoflurane mimics ischaemic preconditioning (producing chemical preconditioning) and thereby protects the myocardium against ischaemic injury in an isolated rat heart model. ⋯ Recovery of LV developed pressure was improved after ischaemic preconditioning [after 60 min reperfusion, mean 63 (SEM 6)% of baseline] compared with the control group [18 (4)% P<0.01] but not by isoflurane, independently of concentration or duration of administration [ISO-1, 17 (2)%, P=0.99 vs control; ISO-2, 12 (3)%, P=0.64; ISO-3, 4 (1)%, P=0.06]. Total creatine kinase release over 1 h of reperfusion was not significantly different between control [251 (36) U g(-1) dry weight] and all isoflurane groups [ISO-1, 346 (24) U g(-1), P=0.30; ISO-2, 313 (33) U g(-1), P=0.73; ISO-3, 407 (40) U g(-1), P=0.03]. These results indicate that pre-ischaemic administration of isoflurane does not cause anaesthetic-induced preconditioning in the isolated rat heart.
-
Randomized Controlled Trial Clinical Trial
Rate of injection through whitacre needles affects distribution of spinal anaesthesia.
A prospective, randomized, double-blind study was performed to investigate whether altering the rate of injection of local anaesthetic through a Whitacre needle had any effect on the spinal block achieved. Twenty patients scheduled for elective urological surgery under spinal anaesthesia received an injection of 3 ml of 0.5% plain bupivacaine either by hand (fast) over 10 s (18 ml min(-1)) or by infusion pump (slow) over 3 min (1 ml min(-1)). All patients were in the sitting position both during insertion of the spinal needle and for 3 min after the start of spinal injection, and they then changed to the supine position. ⋯ The time to lowest mean arterial pressure occurred earlier in the slow group, at 10 (8 to 18) vs 20 (15-31) min (P<0.05). Duration of the motor block was shorter in the slow group: 180 (152-242) vs 270 (225-300). We conclude that a slow spinal injection of plain bupivacaine results in a block of more rapid onset and recovery.