Using a worldwide in-app survey to explore sugammadex usage patterns: a prospective observational study
Editor —Via encapsulation, sugammadex can rapidly and completely reverse even profound neuromuscular block induced by rocuronium or vecuronium, which is not possible to achieve with cholinesterase inhibitors.1 –4 Although approved for use in Europe in 20085 and available for several years elsewhere,6 the United States Food and Drug Administration (US FDA) delayed approval due to concerns regarding potential hypersensitivity reactions and effects on coagulation tests,7 which were ultimately satisfied.8 –10 We are interested in better understanding global experience with sugammadex and the impact, if any, of pharmacoec...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Predicting postoperative brain function from the blood: is there a role for biomarkers?
Loss of consciousness upon exposure to general anaesthetics reflects the powerful influence of these drugs on brain physiology. While this phenomenon is usually transient and rapidly resolves upon discontinuation of drug administration, an overwhelming number of both clinical and experimental observations suggest that even relatively short periods of anaesthesia can trigger a myriad of biochemical pathways which, in turn, can give rise to temporary or even lasting changes in neurobehavioural and cognitive function after emergence from anaesthesia.1 Most of these functional alterations have been described as postoperative d...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Post-anaesthesia care unit delirium: incidence, risk factors and associated adverse outcomes
Delirium is a sudden disturbance in attention and orientation to the environment that develops over a short period of time and tends to fluctuate in severity during the course of the day.1 The acute confusional state of delirium occurs in 50 –80% of critically ill patients and postoperatively (from the day after surgery onwards) in up to 54% of elective major non-cardiac surgical patients.1 It incurs a huge societal burden, because of, in part, a result of its association with increased morbidity and mortality; each additional day of delirium has been independently associated with a 10% increased risk of death.2 Increase...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Postoperative delirium portends descent to dementia
Many elderly patients worry that their thinking will be impaired after surgery. Concerns include acute confusion in the days to weeks following surgery, as well as persistent cognitive deficits lasting months to years.1 Both postoperative delirium (POD) and delayed neurocognitive recovery lasting months after surgery are common in older adults, but reports of non-resolving cognitive decline or neurocognitive disorders (NCDs) are inconsistent.23 The acute onset inattention and disorganized thinking characteristic of POD often manifest between one and four days after surgery.4 Delayed neurocognitive recovery is a subtle NCD ...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Delirium, what ’s in a name?
Delirium has been known since ancient times. Hippocrates [460 –370 Before Common Era (BCE)] may have been the first to describe the syndrome that he called ‘phrenitis’, marked by confusion and restlessness that fluctuated unpredictably and that was associated with physical illness.1 Many other names have been used, including acute mental status change, confusional state, confusion, acute brain dysfunction, brain failure, encephalopathy, postoperative psychosis and acute organic syndrome.1 Of these, the term delirium (derived from the Latin word delirare, deviate from a straight track) has gained acceptance. Besides a...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
How powerful is failure to rescue as a global metric? Not as powerful as a commitment to measurement
In a much-discussed study published in 2009, Dr Ghaferi and colleagues1 revived the concept, originally described in the early 1990s by Jeffrey Silber and colleagues,2 of ‘failure to rescue’. Ghaferi and colleagues1 used a prospective, multicentre clinical registry organized by the American College of Surgeons (ACS-NSQIP) to rank hospitals by mortality quintiles. They then evaluated adverse events and noted that across the different mortality quintiles the risk of an adverse event was remarkably consistent. What differed with respect to mortality was not so much the likelihood of a complication, but the ability of a ho...
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Abstracts for Spring BJA Research Forum meeting, Royal College of Anaesthetists, London, 5th and 6th April 2017
(The authors of all the following abstracts have confirmed that their research received ethics committee approval or was conducted under the Animal (Scientific Procedures) Act (1986) or equivalent.) (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Abstracts from the BJA Research Forum Glasgow, November 10 –11, 2016
(The authors of all the following abstracts have confirmed that their research received ethics committee approval or was conducted under the Animal (Scientific Procedures) Act (1986) or equivalent.) (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 27, 2017 Category: Anesthesiology Source Type: research
Spinal anaesthesia in neonates and infants: what about the cerebral oxygen saturation?
ConclusionsIn neonate and infants, SA did not cause clinically significant variation in cerebral oxygen saturation. Despite a significant decrease in MAP, cerebral auto-regulation seems to remain effective in neonates and not altered by spinal anaesthesia. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 19, 2017 Category: Anesthesiology Source Type: research
Sevoflurane activates hippocampal CA3 kainate receptors (Gluk2) to induce hyperactivity during induction and recovery in a mouse model
ConclusionsWe developed a behavioural model in mice that enabled characterization of sevoflurane-induced hyperactivity. The kainate (GluK2) receptor antagonist attenuated these sevoflurane-induced hyperactivitiesin vivo, suggesting that kainate receptors might be the underlying therapeutic targets for sevoflurane-induced hyperactivities in general anaesthesia. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 19, 2017 Category: Anesthesiology Source Type: research
Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial
Conclusions: Infusion of fibrinogen concentrate triggered by Fibtem A5 ≤15 mm did not improve outcomes in PPH. Pre-specified subgroup analyses suggest that fibrinogen replacement is not required if the Fibtem A5 is > 12 mm or Clauss fibrinogen>2 g litre−1, but an effect below these levels cannot be excluded. The raised fibrinogen at term appears to be a physiological buffer rather than required for haemostasis.Trial registration: ISRCTN46295339 (http://www.isrctn.com/ISRCTN46295339, last accessed 5 July 2017), EudraCT 2012-005511-11 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=201...
Source: British Journal of Anaesthesia - July 19, 2017 Category: Anesthesiology Source Type: research
Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery
Conclusions. These results do not support the use of NIRS-based algorithms for the personalized optimization of cerebral oxygenation in adult cardiac surgery.Clinical trial registration.http://www.controlled-trials.com, ISRCTN 23557269. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 19, 2017 Category: Anesthesiology Source Type: research
Comparison of two stroke volume variation-based goal-directed fluid therapies for supratentorial brain tumour resection: a randomized controlled trial
ConclusionsDuring GDFT for supratentorial brain tumour resection, fluid boluses targeting a lower SVV are more beneficial than a restrictive protocol.Clinical trial registrationNCT02113358. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 17, 2017 Category: Anesthesiology Source Type: research
Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index
Conclusions. The PI is a useful tool for evaluation of successful supraclavicular nerve block. A PI ratio of> 1.4 is a good predictor for block success. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 17, 2017 Category: Anesthesiology Source Type: research
Variations in assessment and certification in postgraduate anaesthesia training: a European survey
ConclusionsAssessment and certification processes in European anaesthesia training are diverse. In many countries, a time-based apprenticeship model is evolving towards a competency-based certification process. This diversity precludes comparison of competence of graduating anaesthetists across Europe. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
