Guidelines on informed consent in anaesthesia: unrealistic, unethical, untenable ….
‘Informed consent’ has become the primary paradigm for protecting the legal rights of patients and guiding the ethical practice of medicine.1 The Association of Anaesthetists of Great Britain and Ireland (AAGBI) ‘informed consent’ guidelines have recently been updated in response to ‘the changing ethical and legal background against which anaesthetists, intensivists and pain specialists, currently work’.2 This guidance aims to advise its members (and others) how to provide information about anaesthesia that respects patient autonomy and stays within the law.3 This raises the question, are we really achieving th...
Source: British Journal of Anaesthesia - October 4, 2017 Category: Anesthesiology Source Type: research
Evidence-based medicine: the clue is in the name
Keane and Berg1 have taken issue with the scientific basis of medicine. Their premise is built on the following three challenges: that ‘science’ (in particular, the randomized controlled trial) is fundamentally unsuited to complex health care; that the evolutionary processes described in economics are a better fit to health care; and that attempts to grade recommendations are unnecessary and unhelpful. Their editorial raises ge nuine concerns and merits careful reading. But this perhaps presents a Utopian fallacy; evidence-based medicine isn’t perfect so it must be replaced. The term ‘evidence-based medicine’ is ...
Source: British Journal of Anaesthesia - October 4, 2017 Category: Anesthesiology Source Type: research
Is science the answer?
Nearly ten years ago, Tobin described the irony that evidence-based medicine (EBM) lacks a sound scientific basis.1 A sentinel paper concluded that most results of medical research were false,2 and now the same author, a well-lauded EBM proponent, argues that even if true, most clinical research is not useful3 and now concedes that EBM has been ‘hijacked’ by ‘vested interests’ including industry and researchers.4 The community expends vast resources on research, yet it has been estimated that there is an 85% ‘waste in the production and reporting of research evidence’.5 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 4, 2017 Category: Anesthesiology Source Type: research
Surgical pleth index: prediction of postoperative pain in children?
Conclusions. The results suggest that a lower ( ≤ 40) than previously published (50) target for SPI may be more appropriate in studies investigating SPI guided anaesthesia in children, if the avoidance of moderate-severe postoperative pain is the main goal.Clinical trial registrationACTRN12616001139460. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 4, 2017 Category: Anesthesiology Source Type: research
Does pharmacokinetic/pharmacodynamic model-guided anaesthesia improve outcome after hip fracture surgery?
Hip fracture affects ∼628 000 patients annually and accounts for ∼200 000 deaths in Europe.1 The EuroHOPE database, which includes seven European countries, revealed that the 30 day mortality rate after hip fracture surgery ranges from 4 to 12% and reaches up to 35% after 1 yr.2 Postoperative complications, such as serious cardiac and pulmonary events, appear most frequently.13 Postoperative delirium occurs often and is associated with increased mortality.4 Improving outcomes for vulnerable elderly hip-fractured patients is a key goal for perioperative care.1 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 4, 2017 Category: Anesthesiology Source Type: research
Big data, small airways, big problems
Some of the earliest airway management interventions in humans occurred in neonates in the 18th century. Small tubes were passed into the oropharynx of newborn children to support ventilation. Later in that century, the Royal Humane Society was developed in the United Kingdom to address adult drowning, and the first approaches to tracheal intubation were described. Airway management expanded from life-saving interventions such as these to the operating theatre to support surgical procedures with required ventilation. In the operating theatre, the focus of new approaches to airway management has been on adults. Unfortunatel...
Source: British Journal of Anaesthesia - October 4, 2017 Category: Anesthesiology Source Type: research
Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial
ConclusionsThe intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.Clinical trial registrationNCT02856087. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 3, 2017 Category: Anesthesiology Source Type: research
Assessment of changes in lactate concentration with intravascular microdialysis during high-risk cardiac surgery using the trend interchangeability method
Conclusions. Microdialysis with a central venous catheter appears to provide reliable absolute blood lactate values. Although changes in blood lactate measurements showed an excellent concordance rate, changes between the two methods were poorly interchangeable with the TIM.Clinical trial registration. NCT02296593. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 3, 2017 Category: Anesthesiology Source Type: research
The efficacy of GlideScope ® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry
ConclusionsDuring difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 3, 2017 Category: Anesthesiology Source Type: research
Influence of Bayesian optimization on the performance of propofol target-controlled infusion
Conclusions. When an accurate population-based PK model was used for propofol TCI, Bayesian adaption of the model improved bias but not precision.Clinical trial registrationDutch Trial Registry NTR4518. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 3, 2017 Category: Anesthesiology Source Type: research
Comparative usability of modern anaesthesia ventilators: a human factors study
ConclusionsThe usability of modern anaesthesia ventilators differs considerably. Interface issues of specific tasks impair the operator ’s efficiency. Eliminating the specific usability issues might improve the operator’s performance and, as a consequence, the patient’s safety. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - October 3, 2017 Category: Anesthesiology Source Type: research
Getting the dose right: anaesthetic drug delivery and the posological sweet spot
Posology, a scientific term not in common usage, is the science of drug dosage; it is thus a branch of clinical pharmacology (or perhaps a synonym of sorts). Combining the Greek words ‘posos’ (how much) and ‘logos’ (science), posology can be thought of more simply as ‘dosology’. In the posology of anaesthesia, the fundamental question anaesthetists must answer each day is: ‘What is the right anaesthetic dosing strategy for my next patient?’ (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 28, 2017 Category: Anesthesiology Source Type: research
Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis
ConclusionsThere is a strong association between both lower e ′ and higher E/e′ and mortality in septic patients. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 28, 2017 Category: Anesthesiology Source Type: research
Human neural correlates of sevoflurane-induced unconsciousness
AbstractSevoflurane, a volatile anaesthetic agent well-tolerated for inhalation induction, provides a useful opportunity to elucidate the processes whereby halogenated ethers disrupt consciousness and cognition. Multiple molecular targets of sevoflurane have been identified, complementing imaging and electrophysiologic markers for the mechanistically obscure progression from wakefulness to unconsciousness. Recent investigations have more precisely detailed scalp EEG activity during this transition, with practical clinical implications. The relative timing of scalp potentials in frontal and parietal EEG signals suggests tha...
Source: British Journal of Anaesthesia - September 28, 2017 Category: Anesthesiology Source Type: research
Prediction of persistent post-surgery pain by preoperative cold pain sensitivity: biomarker development with machine-learning-derived analysis
ConclusionsResults provide a robust exclusion of persistent pain in women with an accuracy of 94.4%. Moreover, results provide further support for the hypothesis that the endogenous pain inhibitory system may play an important role in the process of pain becoming persistent. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 28, 2017 Category: Anesthesiology Source Type: research
