Hypotonic maintenance i.v. fluids are not appropriate in acutely ill patients. Conclusions can't be extrapolated from healthy volunteers
Editor —A critical aspect in the care of acutely ill patients is the administration of i.v. fluids.1 Debate exists in the both pediatric and adult literature regarding the optimal sodium composition of i.v. fluids. Our group has advocated for the use of an isotonic solution, such as 0.9% NaCl (154 mEq litre−1), for the prevention of hospital-acquired hyponatraemia, as hypotonic solutions have been associated with a high incidence of hospital-acquired hyponatraemia and neurologic complications in both children and adults.2 –5 Acutely ill patients have numerous physiological and disease related stimuli for vasopressin ...
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Medical research and the ethics of medical treatments: disability-free survival. Reply from the author
Editor —I read with great interest the comments by Menon and colleagues1 in response to my previous editorial inBritish Journal of Anaestehsia.2 I find their comments very appropriate and level-headed and I have no intention to get into any polemic argument, but would like to clarify a few points: (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Survival with disability. Whose life is it, anyway?
Editor —We read with interest the editorial by Dr Lönnqvist entitled “Medical Research and the Ethics of Medical Treatments: Disability-free Survival”.1 The editorial refers to our study, RESCUEicp, that interrogated the effect of secondary decompressive craniectomy in traumatic brain injury (TBI) patients with refractory intracranial hypertension.2 The editorial states ‘the conclusion to draw is instead that, despite reducing overall mortality, surgery is not associated with any true long-term benefits in this setting; it only increases the number of patients in a vegetative state or suffering serious disability,...
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Postoperative conditions after antagonism of neuromuscular blocking agent and extubation without use of a neuromuscular monitor
Editor —We thank Muggleton& Muggleton1 and Sethi and colleagues2 for their interest in our study.3 In that particular study we measured postoperative haemoglobin oxygen saturation in patients whilst not receiving supplemental oxygen by mask after extubation under so called “blinded conditions”, that is without the use of a neuromuscular monitor but based solely on clinical signs, after antagonism with either sugammadex or neostigmine. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Reply to: Does deep neuromuscular block optimise surgical space better than moderate block?
Editor —We thank the authors1 for the valuable comments on our paper entitled “Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis”.2 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Does deep neuromuscular block optimize surgical space better than moderate block?
Editor —We read with great interest the meta-analysis by Bruintjes"]?> and colleagues.1 We would like to discuss several methodological limitations that may have led this meta-analysis to a wrong conclusion. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Response to ‘Healthcare and ecological economics at a crossroads’
Editor —We thank Odefey and colleagues1 for their thoughtful letter. The authors were appreciative of our article, but were concerned that we did not comprehensively explore issues regarding water use for cleaning reusable anaesthetic equipment. Our article primarily considered the financial costs and carbon footprints associated with processing reusable and single-use anaesthetic equipment.2 We did examine all other environmental footprints routinely examined in life cycle assessment, but noted that apart from water use, these footprints were small and varied little between approaches. Most of the water use for the reus...
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Healthcare and ecological economics at a crossroads. Response to: financial and environmental costs of reusable and single-use anaesthetic equipment
Water relationships would be simple and linear were they not complicated by all those other ways that human beings are connected with and divided from each other. —Stanley Crawford (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Reply to Clutton and colleagues: assessing anaesthesia in rabbits receiving rocuronium
Editor —Thanks to Clutton and colleagues1 for their comments about our paper2. On behalf of my co-authors, I would like to reply regarding two points raised: (i) the welfare of animals in our research; and (ii) the experimental protocol. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Assessing anaesthesia in rabbits receiving rocuronium. Response to: Effects of arterial load variations on dynamic arterial elastance: an experimental study
Editor —The study published by Monge Garcia and colleagues1 in theBritish Journal of Anaesthesia was conducted on 18 rabbits anaesthetized with xylazine and ketamine and paralysed with rocuronium. The authors reported that the study involved procedures that had been approved by the Ethical Committee for Animal Experimentation of the School of Medicine of the University of Cadiz (license 07 –9604), conformed to European Ethical Standards (2012/707/EU) and Spanish Law (RD 53/2013) for the care and use of laboratory animals for experimental research, and adhered to relevant aspects of the ARRIVE guidelines. Consequently, ...
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
In the November issue
This month ’s issue is notable for a wealth of articles on various aspects of paediatric anaesthesia, and digital technology in quality and patient safety. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Low end-tidal carbon dioxide as a marker of severe anaesthetic anaphylaxis: the missing piece of the puzzle?
Perioperative anaphylaxis has assumed increased prominence in recent times with the Royal College of Anaesthetists of Great Britain and Ireland focusing on this topic for the 6th National Audit Project “NAP6”.1 The reporting period for cases has recently closed and as a result analysis from this audit will provide large amounts of data that will help our understanding of the incidence, causes and sequelae of anaphylaxis in 2017. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Perioperative Jehovah's Witnesses: a review
British Journal of Anaesthesia, 2015; 115(5): 676 –687, DOI10.1093/bja/aev161 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 20, 2017 Category: Anesthesiology Source Type: research
Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography
Conclusions. In obese patients, an RM and higher PEEPIND restored EELV, regional ventilation distribution, and oxygenation during anaesthesia, but these differences did not persist after extubation. Therefore, lung protection strategies should include the postoperative period.Clinical trial registration. German clinical trials register DRKS00004199,www.who.int/ictrp/network/drks2/en/. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 16, 2017 Category: Anesthesiology Source Type: research
Attenuation of high-frequency (30 –200 Hz) thalamocortical EEG rhythms as correlate of anaesthetic action: evidence from dexmedetomidine
Conclusions. Dexmedetomidine attenuates high-frequency thalamocortical rhythms, but to a lesser degree than isoflurane and propofol. The main differences between dexmedetomidine and the other anaesthetics involved thalamic rhythms, further substantiating the link between impaired thalamic function and anaesthesia. Increased delta coherence likely reflects cyclic hyperpolarization of thalamocortical networks and may be a marker for loss of consciousness. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 16, 2017 Category: Anesthesiology Source Type: research
