Electroencephalography and delirium in the postoperative period
AbstractDelirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence. EEG offers objective measu...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis
The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve block. The methodology followed the PRISMA statement guidelines. The primary outcome was the duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in morphine i.v. equivalents, pain scores, and complication rates (neurological complications, infection, or hyperglycaemia). Eleven controlled trials, including 914 patients, were identified. The duration of analgesia was signific...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
In This Issue
(Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Association between delirium and cognitive change after cardiac surgery
Conclusions. Postoperative delirium is independently associated with cognitive decline 1 month after surgery, but cognitive performance generally recovers in 1 yr. Patients with a predisposition to POD can be identified before surgery by worse performance in an attention task.Clinical trial registration. NCT00293592. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics
Conclusions: The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Dexmedetomidine pharmacodynamics in healthy volunteers: 2. Haemodynamic profile
Conclusions. The present integrated PKPD model should allow tighter control over the desired level of sedation, while limiting potential haemodynamic side-effects.Clinical trial registration. NCT01879865. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Topics for the national audit projects of the Royal College of Anaesthetists
Editor —Moppett and colleagues1 provide a very fair assessment of the value of the national audit projects (NAPs) performed in the UK during the last decade. However, I would question their statement that the choice of topics for the third and fourth projects performed by the Royal College of Anesthetists (NAP3 and NAP4) was ‘in part serendipitous, as a result of the coincidence of the desires of the specialist societies (Pain and Difficult Airway) and the Royal College of Anaesthetists’. The subjects for both audits were discussed at meetings of College Council and, as a member of that group at the time, I remember ...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
The Princes of Serendip
Editor —We thank Professor Wildsmith1 for his interest in our editorial2 and for clarifying aspects of the process around NAP3.3 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Management of perioperative laryngospasm by French paediatric anaesthetists
Editor —Perioperative laryngospasm is a life-threating emergency in paediatric patients. A recent multicentre study of children undergoing surgery1 found a high rate of severe critical events during the perioperative period (5.2%), with an incidence of respiratory critical events of 3.1%. Laryngospasm was one of most frequent respiratory complications (0.2 –6.7%). Its effective management requires appropriate diagnosis, followed by prompt and aggressive management. The use of a structured algorithm would lead to earlier recognition and better management.2 We undertook a survey in order to explore the practical manageme...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Mind the gap when performing emergency front-of-neck access
Editor —Plan D of the Difficult Airway Society guidelines1 on managing the can ’t intubate can’t oxygenate (CICO) scenario states that a 6.0 mm cuffed tracheal tube should be railroaded over the bougie when performing scalpel cricothyroidotomy. During our departmental CICO training sessions, conducted on sheep larynxes, we have noticed that candidates have difficulties rai lroading the tube over the bougie (Frova Intubating Introducer, Cook Medical Ltd. Limerick, Ireland) when using a 6 mm cuffed tracheal tube. This appears to be caused by the tip of the tube catching on the airway as it is being advanced, because of...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Simulated emergency cricothyroid incision length
Editor —The revised 2015 Difficult Airway Society (DAS) guidelines for the ‘unanticipated difficult airway’ include a standardized approach to performance of emergency front-of-neck access in the ‘can’t intubate, can’t oxygenate’ (CICO) scenario.1 We have subsequently changed how we educate colleagues in the management of a CICO scenario using the surgical technique as part of our airway update days and on the Aintree Difficult Airway Management course. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Approach affects injectate spread in ultrasound-guided thoracic paravertebral block: a cadaveric trial
Editor —Ultrasound-guided thoracic paravertebral block has made much progress, and various approaches have been developed in the past decade.1 However, the differences in local anaesthetic distribution patterns are unknown. We adopted two patterns of injections, namely the intercostal approach (IC approach)2 and the paralaminar in-plane approach (PL approach),34 and compared their injectate spreading patterns in three Thiel-embalmed human cadavers using a dye injection method.56 For the IC approach, a 6 –13 MHz linear array transducer was placed at the T4, T5 and T9 intercostal levels to visualize the transverse proces...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Acute kidney injury following enhanced recovery for orthopaedic joint replacement surgery —role of preoperative kidney disease?
Editor —Enhanced recovery after surgery (ERAS), a multifaceted approach to anaesthesia and surgery, has been implemented widely throughout orthopaedic lower limb arthroplasty.1 The aim is to discontinue i.v. fluids by midday on postoperative day one;2 however, there is marked variation in practice between centres. We sought to determine the incidence of acute kidney injury (AKI) in patients undergoing hip or knee arthroplasty under ERAS principles particular to our unit, where fluids are discontinued before leaving the recovery room. All patients who had undergone primary unilateral lower limb arthroplasty as part of an ...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Ultrasound-guided central venous catheterization in the prone position
Editor —Central venous catheterization for patients positioned prone poses challenges to the anaesthesiologist, such as anatomical restrictions in head and neck position, lack of anatomical landmark points to approach, and difficult right internal jugular vein (RIJV) needle advancement with the left hand . Here we present an approach for RIJV catheterization in a patient positioned prone using in-plane needle ultrasound guidance. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Availability of critical care services in Taiwan under National Health Insurance
Editor —Since the implementation of Taiwan’s National Health Insurance (NHI) programme in 1995, use of health-care services has significantly increased.1 This is also true for the use of mechanical ventilation and extracorporeal membrane oxygenation.23 In contrast, information is limited about use of intensive care unit (ICU) beds.4 We conducted this study to investigate the availability of the critical care service in Taiwan under the NHI programme. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
