British journal of anaesthesia
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Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2-specific inhibitors provide significant analgesic and opioid-sparing benefits. However, these analgesics are commonly avoided owing to concerns of potential adverse effects. The evidence for NSAID-related adverse effects is conflicting and of poor quality, and these analgesics are safer than what has been implied. Thus, it is imperative that NSAIDs or COX-2-specific inhibitors are administered routinely unless there are well-founded contraindications.
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To avoid underdosing or overdosing of analgesic medications, a variety of nociception monitors that use distinct techniques have been developed to quantify nociception during general anaesthesia. Although prior meta-analyses have examined the behaviour of nociception monitors vs standard care protocols, they did not include the potentially valuable data for monitor-to-monitor comparisons. In order to capture these data fully and compare the behaviour of these monitors, we conducted a systematic search and network meta-analysis. ⋯ Apart from pupillometry, no monitors demonstrated a significant effect on intraoperative opioid consumption. Secondary outcomes indicate limited clinical benefit for patients when using these monitors.
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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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Junior anaesthesiologists often find it difficult to gain the trust of surgeons, possibly because of their limited experience and unfamiliarity with surgeons. Therefore, they can face pressure when navigating disagreements with senior surgeons. We investigated whether and how differences in anaesthesiologist-surgeon seniority might impact patient safety. ⋯ The capacity of anaesthesiologists to uphold patient safety was not significantly affected by their seniority levels relative to surgeons.
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Anaesthesia has been shown to impair social functioning, but the underlying mechanisms remain largely unknown. The volatile anaesthetic isoflurane potentially disrupts the methionine cycle and trans-sulphuration pathway, contributing to social deficits. Cystathionine-β-synthase (CBS), a key enzyme in this pathway, might be targeted by isoflurane. We investigated the CBS-isoflurane interaction and its role in neuronal function and social behaviour. ⋯ These findings reveal a crucial role for CBS inhibition by isoflurane in anaesthesia-induced social impairment.