Pectoral nerve block1 versus modified pectoral nerve block2 for postoperative pain relief in patients undergoing modified radical mastectomy: a randomized clinical trial †
ConclusionsmPEC2 provides better postoperative analgesia than PEC1 when catheters are placed under direct vision after MRM.Clinical trial registrationCTRI/2017/02/007811 (REF/2015/11/010185). (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 12, 2017 Category: Anesthesiology Source Type: research
Beta-blockers in sepsis: time to reconsider current constraints?
New insights into the mechanisms of action of beta-blockers, and the potential consequences for clinical practice, are continually evolving. Originally, this class of drugs was targeted towards treatment or prevention of hypertension, arrhythmias and myocardial ischaemia. Their therapeutic potential then expanded towards the reduction of mortality after myocardial infarction and heart failure.1 Although these indications are now widely accepted, they were not immediately apparent. So why may the use of beta-blockers be beneficial in patients already suffering from impaired myocardial contractility? Clinical observations su...
Source: British Journal of Anaesthesia - September 12, 2017 Category: Anesthesiology Source Type: research
Pain in cancer survivors; filling in the gaps
AbstractCancer survivorship represents a growing clinical challenge for pain clinicians. The population of cancer survivors is rapidly expanding and many of these patients experience pain as a sequelae of their disease and its treatment. The features, pathophysiology and natural history of some painful conditions observed in cancer survivors, such as direct tumour effects, cancer induced bone pain (CIBP) or chronic post-surgical pain have received extensive exposure elsewhere in the literature. In this narrative review, we attempt to ‘fill in the gaps’ in the knowledge, by providing a succinct outline of a range of les...
Source: British Journal of Anaesthesia - September 11, 2017 Category: Anesthesiology Source Type: research
Perioperative statins surgery and postoperative pain
In this issue of theBritishJournalof Anaesthesia, Saasouh and colleagues1 evaluated whether statins influence postoperative pain and opioid consumption after hip surgery.1 Using a large and long-established Cleveland Clinic database a group of patients already taking statins were matched with otherwise similar patients who were not. The authors conclude that there was no significant relationship between statin taking and postoperative pain and opioid consumption during the initial 72 h after hip surgery. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Effects of propofol and surgery on neuropathology and cognition in the 3xTgAD Alzheimer transgenic mouse model
Conclusions. Surgery in a vulnerable transgenic mouse under propofol anaesthesia was associated with minimal to no changes in short- and long-term behaviour and no changes in neuropathology. This suggests that propofol anaesthesia is associated with better cognitive outcomes in the aged, vulnerable brain compared with inhalation anaesthesia. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Thinking, fast and slow: highlights from the 2016 BJA seminar on anaesthetic neurotoxicity and neuroplasticity
In his best-selling 2011 book entitled “Thinking Fast and Slow”, Nobel laureate Daniel Kahneman elucidates the contrast between two modes of human thought-processing: fast and slow thinking.1 Fast thinking is characterized by rapid and automatic reaction to a simulation or problem, while slow thinking involves a measured and analytical response. This dichotomy epitomises the clash between clinicians and basic scientists on the enigma of anaesthetic neurotoxicity.2 Based on their clinical practise that anaesthetics do not overtly produce neurocognitive deficits, the clinician ’s viewpoint relies on instinct and experi...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Influence of deep neuromuscular block on the surgeon ś assessment of surgical conditions during laparotomy: a randomized controlled double blinded trial with rocuronium and sugammadex
Conclusions. Deep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy.Clinical trial registration: NCT02140593. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study
Conclusions. Restrictive use of FFP guided by clinical assessment of bleeding and VE-POCT is feasible and did not result in clinically significant haemostatic impairment. Studies should compare the clinical and cost effectiveness of empirical FFP infusions, according to current guidelines, with targeted use of FFP based on VE-POCT.Clinical trial registration: ISRCTN46295339 (http://www.isrctn.com/ISRCTN46295339) (accessed July 24, 2017), EudraCT 2012-005511-11 (https://www.clinicaltrialsregister.eu/ctr-search?query=2011-005511-11) (accessed July 24, 2017). (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
In the September BJA …
This issue of the BJA contains a special section onanaesthetic neurotoxicity and neuroplasticity following a call for papers associated with the Second BJA Seminar on Neurotoxicity and Neuroplasticity held in June 2016 at Churchill House in London. The main issue includes a number of articles relevant to bleeding, transfusion and coagulation incardiac surgery,postpartum haemorrhage, andliver transplantation, as well as important contributions onairway management. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Reply to Chang: After availability, training and experience are needed
Editor —We thank Dr Chang for his kind comments.1 It is becoming increasingly common for videolaryngoscopy to be included in guidelines for the management of difficulty during intubation, and the evidence supports this.23 With this in mind it is a concern that one of the findings of our survey was that, although videolaryngoscopy is available in the vast majority of hospitals, it generally appears to be much less available in areas where intubation fails more frequently (obstetrics, intensive care, emergency department). We hope that this has been addressed since the time the survey was completed, but if this is not the ...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Beyond availability: the importance of routine videolaryngoscopy and institution-based rescue methods of difficult videolaryngoscopy
Editor —We appreciate the fabulous work of Cook and Kelly on the national survey of videolaryngoscopy (VL) in the UK.1 According to the Difficult Airway Society ’s 2015 guidelines2 videolaryngoscopes should be immediately available at all times and all anaesthetists should be trained and skilled in their use. We are glad to see the main finding that VL is available in >90% of UK hospital, though only one in seven hospitals have VL available in all relevant clinical areas. Beyond the availability of videolaryngoscopes, whether to be skilled in VL remains an important issue. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Reply to Lucas and Vaughan: videolaryngoscopy and obstetric anaesthesia?
Editor —We thank Lucas and Vaughan for their comments on our paper.1 Their survey correlates with our survey in 20152 in finding that approximately half of UK obstetric units have a dedicated videolaryngoscope (VL): 42% in the survey of Noblet and colleagues in 20113 and 55% in our survey in 2013.2 A survey by Hales and colleagues, also in 2014, reported that 90% of UK obstetric units have a VL, but this has yet to be published in full.4 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Videolaryngoscopy and obstetric anaesthesia
Editor —We congratulate Professor Cook and Dr Kelly on their important national survey of videolaryngoscopy in the UK.1 They highlighted that while videolaryngoscopes (VLs) are widely available in main operating theatres, availability in other areas where tracheal intubation is undertaken is much lower, being around only 50% of intensive care units and obstetric theatres. We would suggest that this figure is a particular concern to obstetric anaesthesia, where the risk of failed intubation is greater than the general population. In 2011, we conducted a national Obstetric Anaesthetists ’ Association approved survey of t...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Causes of sudden death of young anesthesiologists in China Response to Zhang and colleagues: Rising sudden death among anaethesiologists in China.
Editor —We read with great interest the survey results of Chinese anaesthesiologists by Zhang and colleagues.1 The authors claimed that anaesthesiologists in China are currently suffering from work overload, and sudden death is increasing dramatically. More than 10 anaesthesiologists aged 30 –45 yr had a cardiac arrest as a result of a heavy workload in China from 2013 to 2014.2 The cause of death attributed to cardiac arrest is overly inclusive as one can make the argument that all demise can be eventually attributed to cardiopulmonary arrest. The causal relationship between relative ‘work overload’ and sudden d...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
Response to: Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists
Editor —The work by Greig and colleagues1 brings to light conflicting organizational and management practices for the operating theatre. A majority of the confusion and tension in this high-pressure environment can be traced back to the fundamental misunderstanding of high-reliability organizations (HRO) and ultra-safe systems (USS). In fact, the authors state that “health care providers aspire to become high-reliability organizations, but this practice contrasts with existing high-reliability organizations, such as aviation, where decision-making aids and standardized operating procedures are widely used.”1 However,...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research
