共查询到20条相似文献,搜索用时 31 毫秒
1.
Background. Changes in skin conductance have previously beenreported to correlate well with plasma levels of stress hormonesand awakening stimuli. In this study, monitoring of skin conductanceduring emergence from general anaesthesia was compared withthe monitoring of bispectral index (BIS). Methods. Twenty-five patients undergoing minor elective surgerywere investigated. The number of fluctuations in mean skin conductance(NFSC), BIS and haemodynamic parameters were recorded simultaneously.The performance of the monitoring devices to predict and distinguishbetween the clinical states steady-state anaesthesia,first reaction and extubation werecompared using the method of prediction probability (PK) calculation. Results. Both monitors showed similar performance in distinguishingbetween steady-state anaesthesia vs firstreaction (PK NFSC 0.89; BIS® 0.94) and steady-stateanaesthesia vs extubation (PK NFSC 0.96;BIS® 0.96). The response times of the monitors, to indicatethe likelihood of first reaction, were not significantlydifferent. Conclusions. NFSC, as a parameter of skin conductance, performedsimilarly to BIS in patients waking after a general anaesthetic. 相似文献
2.
《CEACCP》2006,6(5):207-208
The purpose of this section of CEACCP is to provide a forumfor debate and clarification of any controversies arising fromprevious articles. We have received correspondence from Bruce Powell of FremantleHospital, Western Australia in connection with the article Currentcontroversies in neuroanaesthesia, head injury management andneuro critical care by Drs Mishra, Rajkumar and Hancock(CEACCP 2006; 6,2:7982). Dr Powell questions the suggestionthat blood glucose should be strictly maintained at 相似文献
3.
《CEACCP》2007,7(5):177-178
Gordon Drummond of Edinburgh contacted us regarding the articleon Pharmacokinetics and Anaesthesia by Fred Robertsand Dan Freshwater-Turner (CEACCP 2007; 7(1): 25–29).He was unhappy with the assertion that an inhaled drug...crossesthe alveolar membrane into the blood along its partial pressuregradient. This produces an exponential wash-in.... DrDrummond writes that This suggests that the exponentialwash-in is caused by a partial pressure gradient. This is notso. Volatile anaesthetics are believed by almost all to equilibraterapidly and virtually fully, between alveolar gas and alveolarcapillary blood, and 相似文献
4.
Background. There has been little published work on the statisticalfeatures of breath times in postoperative patients. We appliedextreme value theory (a statistical method) to the variationin the timing of postoperative breathing. Methods. We observed 49 patients 36 h after a varietyof surgical procedures, once they had achieved a stable breathingpattern. The breathing patterns could be one of the three typespredicted by the extreme value model. Finite breathingpatterns (n=30) have a finite upper limit of duration for anyapnoea. Patients that displayed one of the other two patterns(standard and extended) have, potentially,no limit in duration of apnoea. Results. The type of breathing pattern observed in each patientwas not reliably identified by most of the commonly used riskfactors (age, type of surgery, opioid type, dose, and routeof administration). A finite pattern was observed in 13 of 26patients receiving epidural (vs 17 of 23 parenteral analgesia:P=0.15), and 15 of 19 receiving morphine (vs 15 of 30 otheropioids: P=0.05). The patients with finite patternswere also significantly less drowsy (score 1.04 (0.92) vs 1.62(0.62), P<0.05). Conclusions. The breathing pattern was not related to mean breathtimes, suggesting that the prevalence of apnoeas cannot be reliablypredicted by measurement of the respiratory rate alone. Br J Anaesth 2002; 88: 614 相似文献
5.
Ledowski T Bromilow J Paech MJ Storm H Hacking R Schug SA 《British journal of anaesthesia》2006,97(6):817-821
Background. Arousal after sevoflurane anaesthesia has been detectableby monitoring changes in skin conductance (SC) with similaraccuracy as monitoring Bispectral Index (BIS®). As SC monitoringdetects changes in sympathetic tone, the measurements mightbe confounded by the sympatholytic properties of propofol, acomponent of total i.v. anaesthesia (TIVA). Therefore in thisstudy, monitoring of SC during emergence from TIVA was comparedwith the monitoring of BIS®. Methods. Twenty-five patients undergoing plastic surgery wereinvestigated. The number of fluctuations of SC per second (NFSC),BIS® and haemodynamic variables [systolic blood pressure(SBP) and heart rate (HR)] were recorded simultaneously. Theperformance of the monitoring devices in distinguishing betweenthe clinical states steady-state anaesthesia,first clinical reaction and extubationwere compared using the method of prediction probability (Pk)calculation. Results. BIS® showed the best performance in distinguishingbetween steady-state anaesthesia and firstreaction (Pk BIS® 0.99 vs NFSC 0.80; P<0.01),and steady-state anaesthesia and extubation(Pk BIS® 1.00 vs NFSC 0.91; P<0.05); the time from firstchange of BIS® or NFSC to a first clinical reaction wassignificantly longer for NFSC (median BIS® 135 s vs NFSC191 s; P<0.05). BIS® and NFSC performed better in distinguishingbetween the investigated clinical states than SBP and HR. Conclusions. In this study, BIS® was found to predict arousalwith a higher probability but slower response times than NFSCin patients waking after TIVA. 相似文献
6.
Cardioprotective effects of desflurane: effect of timing and duration of administration in rat myocardium 总被引:1,自引:0,他引:1
Haelewyn B Zhu L Hanouz JL Persehaye E Roussel S Ducouret P Gérard JL 《British journal of anaesthesia》2004,92(4):552-557
Background. We compared the cardioprotective effects of 1 minimumalveolar concentration (MAC) desflurane administered before,during or after ischaemia, or throughout the experiment (before,during and after ischaemia) on myocardial infarct size following30 min occlusion of the left anterior descending coronary arteryand 3 h reperfusion in adult rats. Methods. Fifty male SpragueDawley rats were anaesthetizedwith pentobarbital, intubated and mechanically ventilated. Bloodgases, pH and body temperature (37.538°C) were controlled.Heart rate and arterial pressure were measured continuously.Animals were randomly assigned to the following groups (n=10in each group): pentobarbital only (Pento); 15min desflurane administration followed by 10 min of washoutbefore 30 min ischaemia and 3 h reperfusion (Precond);30 min desflurane administration during ischaemia period (Isch);desflurane administration during the 15 first min of reperfusion(Reperf) and desflurane administration throughoutthe experiment (before, during and after ischaemia; Long).Volumes at risk and infarct sizes were assessed by Indian inkand with 2,3,5-triphenyltetrazolium chloride staining, respectively. Results. Physiological parameters and volumes at risk were notsignificantly different between groups. In the Pento group,mean myocardial infarct size was 65 (SD 15)% of the volume atrisk; myocardial infarct size was reduced to a significant andcomparable extent in the desflurane-treated groups (Precond42 (14)%; Isch 34 (11)%; Reperf 41 (15)%; Long 33 (10)%; P<0.0002vs Pento group). Conclusions. In rats, desflurane 1 MAC significantly decreasedmyocardial infarct size whatever the period and duration ofadministration. Br J Anaesth 2004; 92: 5527 相似文献
7.
Stress in UK intensive care unit doctors 总被引:4,自引:0,他引:4
Coomber S Todd C Park G Baxter P Firth-Cozens J Shore S 《British journal of anaesthesia》2002,89(6):873-881
Background. Doctors have long been considered at risk of occupationalstress. Methods. A postal survey of all members of the Intensive CareSociety using validated instruments. Results. Eight-five per cent of members returned questionnairesand 70% were eligible for the study. Twenty-nine per cent weresuffering General Health Questionnaire-12 (GHQ-12) identifieddistress and 12% Symptom Checklist-Depression (SCL-D) defineddepression. There were no significant age or sex differencesbetween staff suffering distress or depression and those whodid not. Dissatisfaction with career correlated highly withboth distress and depression (P<0.01). Twenty doctors (3%)were bothered by suicidal thoughts. The most stressful aspectsof work were bed allocation, being over-stretched, effect ofhours of work and stress on personal/family life, and compromisingstandards when resources are short. Logistic regression revealedmental health problems were predicted by five stressors: lackof recognition of ones own contribution by others;too much responsibility at times; effectof stress on personal/family life; keeping upto date with knowledge; and making the right decisionalone. Conclusions. Nearly one in three ICU doctors appeared distressed(GHQ), and one in 10 depressed (SCL-D); this is no greater thanthat reported in other specialities. Perceived stressors revealsome key areas of concern for the employer and the specialty. Br J Anaesth 2002; 89: 87381 相似文献
8.
Background. Tracheal intubation combined with controlled ventilationof the lungs is an important part of the prehospital managementof major trauma victims, but gauging the adequacy of ventilationremains a major problem. Methods. Ninety-seven major trauma victims who underwent trachealintubation in the field and controlled ventilation of the lungsduring prehospital treatment by a Helicopter Emergency MedicalService were assigned randomly to one of two groups: (1) monitorgroup (n=57) and (2) monitor-blind group (n=40), according towhether the anaesthetist could or could not see an attachedcapnograph screen. In the monitor-blind group ventilation wasset by using a tidal-volume of 10 ml kg1 estimated bodyweight and an age-appropriate ventilatory frequency. In themonitor group, ventilation was adjusted to achieve target end-tidalcarbon dioxide values determined by the physiologicalstate of the trauma victim. Arterial blood gases weremeasured upon hospital admission while maintaining the ventilationinitiated in the field and the PaCO2 value obtained was usedas the determinant of the adequacy of prehospital ventilation. Results. The incidence of normoventilation wassignificantly higher (63.2 vs 20%; P<0.0001) and the incidenceof hypoventilation upon hospital admission wassignificantly lower (5.3 vs 37.5%; P<0.0001) in the monitorgroup; patients with severe head and chest trauma and haemodynamicallyunstable patients and those with a high injury severity scorewere significantly more likely to be normoventilatedupon hospital admission in the monitor group than in the monitor-blindgroup. Conclusions. The data support the routine use of prehospitalcapnographic monitoring using target end-tidal carbon dioxidevalues adapted to the physiological state of the patient inmajor trauma victims requiring tracheal intubation in the field. Br J Anaesth 2003; 90: 32732 相似文献
9.
Vermeulen PM Kalkman CJ Dirksen R Knape JT Moons KG Borm GF 《British journal of anaesthesia》2002,88(1):38-45
Background. The disposition of inhalation anaesthetics is governedby the factors described in the Fick principle. Methods. We have recalibrated a previously validated physiologicalmodel for enflurane closed-circuit inhalation anaesthesia, usingindividual continuous cardiac output measurements as well asage-related enflurane solubility coefficients as inputs to themodel. Two model versions using calculated (Brodysformula) or measured (thoracic electrical bioimpedance)cardiac output values, and two versions with standard(fixed) or age-related solubility coefficientswere formulated. Results. Data from 62 ophthalmic surgical patients were usedto validate the predictive performance of the four model versions.The root mean squared errors (total error) and scatters (errorvariation) were similar with the extended model versions, butthe group biases (systematic error component) were significantlyless with the model versions that included age-related solubilitycompared with the versions using standard solubility coefficients(bias 0.76/0.78% vs 3.44/3.60%). Conclusion. The inclusion of age-related solubility coefficientsbut not of continuous cardiac output measurements improves thepredictive performance of the physiological model for closed-circuitinhalation anaesthetic conditions in routine clinical practice. Br J Anaesth 2002; 88: 3845 相似文献
10.
《CEACCP》2005,5(4):138-139
The purpose of this section of CEACCP is to provide a forumfor debate and clarification of any controversies arising fromprevious articles This month we received correspondence from Drs Andy Petros,Richard Sarginson, Mark Fox and Rick van Saene of London andLiverpool commenting on the article by Ken Inweregbu, JayshreeDave and Alison Pittard on Nosocomial infections(CEACCP 2005; 5: 1417). Dr Petros and colleagues stated 相似文献
11.
《CEACCP》2005,5(5):175
The purpose of this section of CEACCP is to provide a forumfor debate and clarification of any controversies arising fromprevious articles David Levy of Nottingham queried the statement regarding i.v.anaesthetic agents in the elderly that Reduced hepaticclearance leads to an increased recovery time even when givenat the correct dose (CEACCP 2004; 4: 1936). DrLevy wrote 相似文献
12.
《CEACCP》2004,4(1):28
The purpose of this section of CEACCP is to provide a forumfor debate and clarification of any controversies arising fromprevious articles. We have received correspondence relating to two topics in theOctober 2003 edition of BJA CEPD Reviews. Dr Jeremy Weinbren of London commented on the article on Percutaneoustracheostomy by 相似文献
13.
Heidegger T Husemann Y Nuebling M Morf D Sieber T Huth A Germann R Innerhofer P Faserl A Schubert C Geibinger C Flückiger K Coi T Kreienbühl G 《British journal of anaesthesia》2002,89(6):863-872
Background. We describe the development and comparison of apsychometric questionnaire on patient satisfaction with anaesthesiacare among six hospitals. Methods. We used a rigorous protocol: generation of items, constructionof the pilot questionnaire, pilot study, statistical analysis(construct validity, factor analysis, reliability analysis),compilation of the final questionnaire, main study, repeatedanalysis of construct validity and reliability. We comparedthe mean total problem score and the scores for the dimensions:Information/Involvement in decision-making, andContinuity of personal care by anaesthetist. Theinfluence of potential confounding variables was tested (multiplelinear regression). Results. The average problem score from all hospitals was 18.6%.Most problems are mentioned in the dimensions Information/Involvementin decision-making (mean problem score: 30.9%) and Continuityof personal care by anaesthetist (mean problem score:32.2%). The overall assessment of the quality of anaesthesiacare was good to excellent in 98.7% of cases. The most importantdimension was Information/Involvement in decision-making.The mean total problem score was significantly lower for twohospitals than the total mean for all hospitals (significantlyhigher at two hospitals) (P<0.05). Amongst the confoundingvariables considered, age, sex, subjective state of health,type of anaesthesia and level of education had an influenceon the total problem score and the two dimensions mentioned.There were only marginal differences with and without the influenceof the confounding variables for the different hospitals. Conclusions. A psychometric questionnaire on patient satisfactionwith anaesthesia care must cover areas such as patient information,involvement in decision-making, and contact with the anaesthetist.The assessment using summed scores for dimensions is more informativethan a global summed rating. There were significant differencesbetween hospitals. Moreover, the high problem scores indicatea great potential for improvement at all hospitals. Br J Anaesth 2002; 89: 86372 相似文献
14.
Enhanced visual memory effect for negative versus positive emotional content is potentiated at sub-anaesthetic concentrations of thiopental 总被引:2,自引:1,他引:1
Background. Emotional information has the ability to alter theformation and strength of a memory (memory modulation).Memory modulation by negative emotion is mediated by the amygdala.It is not known how gamma aminobutyric acid (GABA)ergic drugsaffect the processes involved in memory modulation. This studyinvestigates whether memory for negative emotional stimuli ismore refractory to the effects of GABAergic drugs. Methods. Eighty-three healthy volunteers were shown a randomizedsequence of 60 visual stimuli consisting of negative, positiveand neutral emotive pictures, while receiving a controlled infusionof thiopental (n=31), propofol (n=31), dexmedetomidine (n=10)or placebo (n=11). After a 5 h retention interval, when drugconcentration was negligible, subjects performed a recognitiontask with old pictures randomly mixed with newpictures. Drug effect was calculated as the proportionate reductionin recognition for images of each emotional valence. Results. Forty-eight subjects were included in a within-subjectlogistic doseresponse model analysis. In the thiopentalgroup there was a smaller drug effect seen for negative vs positiveimages (proportional memory reduction from baseline 0.27 (SD0.20) vs 0.56 (0.25), P<0.001, n=20 included in analysis).A similar trend was seen in the propofol group (0.25 (0.28)vs 0.54 (0.30), n=10), but this did not attain statistical significance.No trend was seen in the dexmedetomidine group (0.33 (0.26)vs 0.24 (0.22), n=7). Conclusions. Over a specific dose range of thiopental (targetserum concentration 27 µg ml1), impairmentof explicit memory for images with negative emotional valenceis less than that for images with positive emotional valence.There is a strong possibility that propofol (target serum concentration0.32.4 µg ml1) causes a similar effect.Modulation of visual memory by negative emotional content continuesat sub-anaesthetic concentrations of GABAergic drugs associatedwith explicit memory impairment. 相似文献
15.
Background. Caudal analgesia is widely used in paediatric anaestheticpractice. In adults, the whoosh test has beenrecommended as a guide to successful needle insertion, but ithas not been extensively studied in paediatric patients. Wehave investigated a modification of the whooshtest, which we have christened the swoosh test.It avoids the injection of air by performing auscultation duringinjection of the local anaesthetic solution. We have comparedit with clinical judgement of correct placement. Methods. We studied 113 children undergoing elective surgery.During insertion of the caudal block, a stethoscope was placedover the lower lumbar spine and the presence or absence of anaudible swoosh noted. The operators clinicalimpression of successful insertion was also recorded. Results. The overall success rate of caudal anaesthesia was95.6%. Of the 108 patients with a successful block, 98 had apositive swoosh test. There were no false positiveresults. Calculations show the swoosh test tohave a sensitivity of 91%, a specificity of 100% and a positivepredictive value of 100%. Conclusions. The swoosh test is a simple and accuratetest to confirm successful caudal insertion in children, andis especially useful as a teaching aid for anaesthetists newto the technique. Br J Anaesth 2003; 90: 625 相似文献
16.
《CEACCP》2006,6(1):41
The purpose of this section of CEACCP is to provide a forumfor debate and clarification of any controversies arising fromprevious articles We have received correspondence from David Elcock of Shrewsburyregarding the article on Nitrous Oxide by Amelia Banks and JonathanHardman (CEACCP 2005, 5,5: 1458), in which it was statedthat filling ratios of nitrous oxide cylinders are less in tropicalcountries. Dr 相似文献
17.
Background. Patients with drug allergies are commonplace inanaesthetic practice. We investigated the incidence and natureof drug allergies reported by surgical patientsattending a hospital pre-admission clinic, and went on to ascertainto what degree drug allergies recorded in the records influenceddrug prescribing during the patients hospital stay anddetermine whether any adverse events occurred in relation todrug prescribing in this population. Methods. Patients attending for anaesthetic assessment at aPre-Admission Clinic over a 30 week period were questioned concerningdrug allergies. Medical records of these patients were thenexamined after their hospitalization to assess medications prescribedduring that period. Results. Of 1260 patients attending the Pre-admission clinicduring the study period 420 (33.4%) claimed to have a totalof 644 individual drug allergies. The most commonagents implicated were antibiotics (n=272), opioid analgesics(n=118) and NSAIDs (n=62); the most common form of these reactionswere dermatological (n=254) and nausea and vomiting (n=124).There were 41 self-reports specifically of anaphylaxis and afurther 61 where there was significant respiratory system involvement. Conclusions. The majority of the self-reported allergies werein fact simply accepted adverse effects of the drugs concerned.The patients reported drug allergy historywas generally well respected by anaesthetists and other medicalstaff. There were 13 incidents, mainly involving morphine, wherepatients were given a drug to which they had claimed a specificallergy. There were 101 incidents in 89 patients where drugsof the same pharmacological group as that of their allergicdrug were used. There were no untoward reactions in 84 patientswho had claimed a prior adverse reaction to penicillin who weregiven cephalosporins. There were no sequelae from any otherevents. While anaesthetists generally respected patients self-reportedallergies', more attention needs to be paid to the accuraterecording of patients events and a clear distinctionshould be made both in medical records and to the patient betweentrue drug allergy and simple adverse drug reactions. 相似文献
18.
Background. We used the Delphi technique to gain a consensusfrom 26 consultant anaesthetists about technical tasks duringgeneral anaesthesia. We then developed a technical scoring systemto assess anaesthetists undertaking general anaesthesia withrapid sequence induction. Methods. We then followed the performance of six novice anaesthetistson five occasions during their first 3 months of training. Ateach, visit each novice anaesthetized the HumanPatient Simulator at Bristol Medical Simulator Centre. For comparisonseven post-fellowship anaesthetists were scored on one occasion. Results. Novice scores improved significantly over the 12-weekperiod (P<0.01). A significant difference was also foundbetween the final novice scores and the post-fellowship subjects(P<0.05). Conclusions. These findings suggest that simulation can be usedto observe and quantify technical performance. Br J Anaesth 2002; 88: 33844 相似文献
19.
Desflurane affords greater protection than halothane against focal cerebral ischaemia in the rat 总被引:8,自引:0,他引:8
Haelewyn B Yvon A Hanouz JL MacKenzie ET Ducouret P Gérard JL Roussel S 《British journal of anaesthesia》2003,91(3):390-396
Background. We studied the potential neuroprotective effectsof halothane and desflurane, compared with the awake state,on infarct size following 2 h of intraluminal middle cerebralartery occlusion (MCAo) and 22 h of reperfusion. Methods. Male SpragueDawley rats were anaesthetized withdesflurane or halothane, intubated, and mechanically ventilated.Mean arterial pressure (MAP), blood gases, and pH were controlled.Body temperature was maintained at 37.538°C. Animalswere assigned to one of four groups according to the anaesthetictype (halothane or desflurane) and the duration of anaesthesia:short-duration, during the preparation only; long-duration,during both preparation and ischaemia. Twenty-four hours afterMCAo, infarcts were visualized by staining with 2,3,5-triphenyltetrazoliumchloride. Two additional groups of rats were subjected to thesame protocol as that of long-duration halothane and long-durationdesflurane with additional pericranial temperature measurementsmade. Results. Physiological parameters were comparable between thegroups but MAP was higher (P<0.0001) in the short-durationgroups. In the short-duration groups, cerebral infarct volumeswere not significantly different between anaesthetics (short-durationhalothane: 288 (61) mm3, mean (SD); short-duration desflurane:269 (71) mm3, P>0.56). Compared with the awake state (short-durationgroups), halothane and desflurane significantly reduced infarctvolumes (long-duration halothane: 199 (54) mm3, P<0.0047vs short-duration halothane; long-duration desflurane: 121 (55)mm3, P<0.0001 vs short-duration desflurane). The mean infarctvolume in the long-duration desflurane group was significantlylower than that in the long-duration halothane group (P<0.0053).Pericranial temperatures were similar in the desflurane andhalothane long-duration groups (P>0.17). Conclusions. In rats, desflurane-induced neuroprotection againstfocal cerebral ischaemia was greater than that conferred byhalothane. Br J Anaesth 2003; 91: 3906 相似文献
20.
Background. Soluble pulmonary vasoconstrictors released in responseto hypoxia have been reported in pig and rat preparations, butnot in rabbit preparations. Methods. We used myography to evaluate the contribution of asoluble factor to constriction in rabbit small pulmonary arteries(external diameter 300475 µm) exposed to 45 minhypoxia (PO2=9 mm Hg). Results. Hypoxia produced gradually intensifying constriction.Return to euoxia (PO2=145 mm Hg) for 30 min relaxed onlyapproximately 30% of the constriction, whereas elution of themyograph bath yielded full relaxation. Reapplication of theeluent gradually restored the constriction to its pre-elutionlevel over a 30-min period. Conclusions. In this closed system, a soluble factor contributessubstantially to hypoxic pulmonary vasoconstriction. Br J Anaesth 2003; 91: 5924 相似文献