Ultrasound-guided percutaneous cryoneurolysis for treatment of acute pain: could cryoanalgesia replace continuous peripheral nerve blocks?
Local anaesthetics, delivered percutaneously through a needle, have been used for over a century to provide perioperative anaesthesia and analgesia. However, the duration of a single-injection peripheral nerve block is usually limited to less than 24 hr, leaving untreated surgical pain that may last for weeks—or in some cases months. While prolonged analgesia may be provided using a perineural catheter and repeated/continuous administration of local anaesthetic, the duration of this modality is still usually limited to less than one week be cause of the risk of infection, rapid consumption of the local anaesthetic, an...
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
What do recent human studies tell us about the association between anaesthesia in young children and neurodevelopmental outcomes?
AbstractAnaesthetic and sedative drugs transiently disrupt normal neural activity to facilitate healthcare procedures in children, but they can also cause long-term brain injury in experimental animal models. The US Food and Drug Administration (FDA) has recently advised that repeated or lengthy exposures to anaesthetic and sedative drugs prior to 3 yr of age have the potential to harm the development of children’s brains and added warnings to these drug labels. Paediatric anaesthesia toxicity could represent a significant public health issue, and concern about this potential injury in children has become an important...
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
Duration of general anaesthetic exposure in early childhood and long-term language and cognitive ability
Conclusions. Children with VA exposures ≤35 min did not differ from unexposed children, but those with exposures >35 min had lower total and expressive language scores. It remains unclear if this is a dose-response relationship, or if children requiring longer exposures for longer surgeries have other clinical reasons for lower scores. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
Isoflurane exposure for three hours triggers apoptotic cell death in neonatal macaque brain
Conclusions: A 3 h exposure to ISO is sufficient to induce widespread neurotoxicity in the developing primate brain. These results are relevant for clinical medicine, as many surgical and diagnostic procedures in children require anaesthesia durations similar to those modelled here. Further research is necessary to identify long-term neurobehavioural consequences of 3 h ISO exposure. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
Inhibition of p75 neurotrophin receptor does not rescue cognitive impairment in adulthood after isoflurane exposure in neonatal mice
Conclusion: A single isoflurane exposure to early post-natal mice caused a hippocampal-dependent memory deficit that was not prevented by pre-administration of TAT-Pep5, although TAT-Pep5, an inhibitor of p75NTR, has been shown to reduce isoflurane-induced apoptosis. These findings suggest that neuronal apoptosis is not requisite for the development of cognitive deficits in the adults attendant with neonatal anaesthetic exposure. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
Reproducibility of science and developmental anaesthesia neurotoxicity: a tale of two cities
Editor —Reproducing scientific observations is the foundation of trusted discoveries. In clinical sciences, specific questions are repeatedly asked by a multitude of observational studies or trials, and the rigorous meta-analysis of these multicentre datasets leads us closer toward the application of evi dence-based medicine in our patients. A similar approach is less frequently applied to basic and even translational research, where differences in experimental protocols used, species studied, and outcome measures reported make direct comparison of laboratory studies at best very difficult.1 The seeming lack of interest ...
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
How big data shape paediatric anaesthesia
Paediatric anaesthesia practise is changing. This change is primarily the result of new evidence emerging from analyses of large datasets and represents a shift in focus from prevention of perioperative mortality towards a reduction of perioperative morbidity. Children do offer the unique opportunity to study the lifelong consequences of any early intervention. The effects of early-life surgical and anaesthetic exposure may resonate through adolescence and into adulthood. Therefore, it appears necessary to perform long-term follow-up over several years until higher cognitive and other physiological functions have been full...
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
21st Annual Scientific Meeting of the Difficult Airway Society: lessons learned and glimpses of the future
The 21st Annual Scientific Meeting of the Difficult Airway Society (DAS) took place in Torquay (Devon, UK) on November 16 –18, 2016. The workshop day included traditional workshops, a tracheostomy workshop, and a ‘can’t intubate, can’t oxygenate’ (CICO) workshop. The next 2 days encompassed a variety of stimulating sessions, presentations, lunchtime symposia, a pro–con debate, free paper presentations, and poster presentations. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
Prognostic significance of central venous-to-arterial carbon dioxide difference during the first 24 hours of septic shock in patients with and without impaired cardiac function
Conclusion: Patients with septic shock and with AF and/or low LVEF were more prone to a persistent high cv-art CO2 gap, even when initial resuscitation succeeded in normalizing MAP, CVP, and ScvO2. In these patients, a persistent high cv-art CO2 gap at 12 h was significantly associated with higher day 28 mortality. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
Dexmedetomidine pharmacokinetic –pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation
Conclusions. The new pharmacokinetic –pharmacodynamic models might be used for effect-site rather than plasma concentration target-controlled infusion for dexmedetomidine in clinical practice, thereby allowing tighter control over the desired level of sedation.Clinical trial registration. NCT01879865. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 14, 2017 Category: Anesthesiology Source Type: research
Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery
Conclusions. Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 8, 2017 Category: Anesthesiology Source Type: research
Intraoperative dexamethasone alters immune cell populations in patients undergoing elective laparoscopic gynaecological surgery
Conclusions. In female patients undergoing elective laparoscopic gynaecological surgery, dexamethasone administration appears to attenuate inflammation and to alter immune cell counts at 24 h, with no effects identified after this time. The importance of these changes for postoperative immune function is unknown.Trial registration. Australia and New Zealand Clinical Trials Registry (ACTRN12608000340336). (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 8, 2017 Category: Anesthesiology Source Type: research
Duty of candour: a statutory obligation or just the right thing to do?
This article discusses the UK statutory Duty of Candour (DoC) and the implications for enacting the legislation with respect to perioperative and intensive care medicine. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 8, 2017 Category: Anesthesiology Source Type: research
Black swans: challenging the relationship of anaesthetic-induced unconsciousness and electroencephalographic oscillations in the frontal cortex
The study of general anaesthesia and electroencephalographic oscillations in the frontal cortex spans at least four decades, with several notable findings:In 1977, Tinker and colleagues1 proposed, based on studies of the nonhuman primate, that anteriorization —the shift of electroencephalographic power from posterior cortex to frontal cortex—correlated with unresponsiveness during general anaesthesia.In the early 1990s, Steriade contributed to our understanding of the neurophysiology of sleep and general anaesthesia in animals, including descriptions of three distinct oscillations involving corticothalamic networks: a ...
Source: British Journal of Anaesthesia - July 6, 2017 Category: Anesthesiology Source Type: research
Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement
Conclusions: In this detailed prospective cohort study, preoperative high-dose glucocorticoid administration was not associated with LOS>4 days, readmissions or infectious complications in TKA patients without contraindications.Clinical trial registration: NCT01515670. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - July 1, 2017 Category: Anesthesiology Source Type: research
