Abstract:
BACKGROUND:Hip fracture is a condition with high mortality and morbidity in elderly frail patients. Intraoperative fluid optimization may be associated with benefit in this population. We investigated whether intraoperative fluid management using pulse-contour analysis cardiac monitoring, compared with standard care in patients undergoing spinal anaesthesia, would provide benefits in terms of reduced time until medically fit for discharge and postoperative complications. METHODS:Patients undergoing surgical repair of fractured neck of femur, aged >60 yr, receiving spinal anaesthesia were enrolled in this single-centre, blinded, randomized, parallel group trial. Patients were allocated to either anaesthetist-directed fluid therapy or a pulse-contour-guided fluid optimization strategy using colloid (Gelofusine) boluses to optimize stroke volume. The primary outcome was time until medically fit for discharge. Secondary outcomes included postoperative complications, mobility, and mortality. We updated a systematic review to include relevant trials to 2014. RESULTS:We recruited 130 patients. Time until medically fit for discharge was similar in both groups, mean [95% confidence interval (CI)] 12.2 (11.1-13.5) vs 13.1 (11.9-14.5) days (P=0.31), as was total length of stay 14.2 (12.9-15.8) vs 15.3 (13.8-17.2) days (P=0.32). There were no significant differences in complications, function, or mortality. An updated meta-analysis (four studies, 355 patients) found non-significant reduction in early mortality [relative risk 0.66 (0.24-1.79)] and in-hospital complications [relative risk 0.80 (0.61-1.05)]. CONCLUSIONS:Goal-directed fluid therapy during hip fracture repair under spinal anaesthesia does not result in a significant reduction in length of stay or postoperative complications. There is insufficient evidence to either support or discount its routine use. CLINICAL TRIAL REGISTRATION:ISRCTN88284896.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Moppett IK,Rowlands M,Mannings A,Moran CG,Wiles MD,NOTTS Investigators.doi
10.1093/bja/aeu386subject
Has Abstractpub_date
2015-03-01 00:00:00pages
444-59issue
3eissn
0007-0912issn
1471-6771pii
S0007-0912(17)31811-1journal_volume
114pub_type
杂志文章,随机对照试验abstract::Intrathecal midazolam causes antinociception by combining with spinal cord benzodiazepine receptors. This effect is reversible with doses of naloxone, suggesting involvement of spinal kappa or delta but not mu opioid receptors. The antinociceptive effects of intrathecally administered drugs in the spinal cord were dem...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/77.6.758
更新日期:1996-12-01 00:00:00
abstract:BACKGROUND:Lidocaine is frequently used as an agent to treat ventricular arrhythmias associated with acute myocardial ischaemia. Lidocaine is a potent blocker not only of sodium channels, but also of ATP-sensitive potassium channels. The opening of these channels is a key mechanism of ischaemic preconditioning. We inve...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeh262
更新日期:2004-11-01 00:00:00
abstract::We investigated the effect of incision and sternotomy on the auditory evoked potential (AEP) and EEG, to try to predict a haemodynamic response to incision or sternotomy using the AEP and EEG in 41 patients undergoing cardiac surgery during propofol and alfentanil anaesthesia. The AEP and EEG were recorded before inci...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.5.685
更新日期:1996-05-01 00:00:00
abstract::Profound postoperative respiratory depression after larger doses of fentanyl was partially reversed by 4-aminopyridine. This reversal was independent of FIO2' suggesting that the response was not dependent upon peripheral chemoreceptor-mediated drive. Similar reversal of fentanyl-induced depression by 4-aminopyridine ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.4.373
更新日期:1981-04-01 00:00:00
abstract::We have used mivacurium in four myasthenic patients presenting for thymectomy. Supramaximal single twitch stimulation was applied to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis was measured. After an initial bolus dose of 30 micrograms kg-1 (approximately one-fifth of the normal ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/73.4.494
更新日期:1994-10-01 00:00:00
abstract::We have assessed neuromuscular block electromyographically at the gastrocnemius muscle and compared it with that at the abductor digiti minimi muscle in 60 adult patients undergoing cervical spine surgery under general anaesthesia. All patients were in the prone position. After vecuronium 0.2 mg kg-1, times to onset o...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,收录出版
doi:10.1093/bja/82.3.329
更新日期:1999-03-01 00:00:00
abstract::Dysregulation of the immuno-inflammatory response, as seen in sepsis, may culminate in host cell and organ damage. Lipopolysaccharide from Gram-negative bacterial cell walls induces gene activation and subsequent inflammatory mediator expression. Gene activation is regulated by a number of transcription factors at the...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aeg034
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:Paravertebral regional anaesthesia is used to treat pain after several surgical procedures. This study aimed to improve on our first published ultrasound-guided approach to the paravertebral space (PVS) and to investigate a possible discrepancy between the needle, catheter, and contrast dye position. METHOD...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeq309
更新日期:2011-02-01 00:00:00
abstract::Thiopental is a racemate of equimolar R- and S-thiopental enantiomers that have different potencies in laboratory experiments. We measured concentrations of R- and S-thiopental in plasma, tissues and brain microdialysate of rats after computer-controlled infusion of thiopental i.v. to a plasma concentration of 40 micr...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/oxfordjournals.bja.a013385
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:In a prospective, randomized, double-blind, placebo-controlled trial, we investigated the effect of adding meperidine 10 mg to intrathecal bupivacaine on the duration of early postoperative analgesia in 40 patients having elective Caesarean section under spinal anaesthesia. METHODS:Patients received intrath...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/88.3.379
更新日期:2002-03-01 00:00:00
abstract::Blood samples were obtained from a radial artery cannula in a 60-yr-old man during coronary artery surgery. Serum potassium concentrations of 9.3, 8.4, and 7.4 mmol litre(-1) were obtained. A simultaneous venous blood sample gave a serum potassium concentration of 4.4 mmol litre(-1). The ECG was unchanged. After the a...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeh199
更新日期:2004-09-01 00:00:00
abstract::To assess the effect of sevoflurane anaesthesia on hepatocellular integrity, we measured plasma concentrations of glutathione S-transferase (GST) before anaesthesia and 1, 3, 6 and 24 h after the end of anaesthesia in 41 healthy, Japanese patients undergoing elective, body surface surgery. Sevoflurane (approximately 1...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/77.3.404
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Overt stroke after non-cardiac surgery has a substantial impact on the duration and quality of life. Covert stroke in the non-surgical setting is much more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardia...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究
doi:10.1093/bja/aew179
更新日期:2016-08-01 00:00:00
abstract::Thirteen of 31 Belgian Landrace pigs developed malignant hyperthermia (MH) after breathing halothane. A short period of exercise 1 h before the administration of the triggering agent increased the incidence of the syndrome to 100% in eight similar pigs. Clinical symptoms were more marked and developed more rapidly in ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.9.821
更新日期:1976-09-01 00:00:00
abstract::We have compared the antagonism of neuromuscular block produced by pipecuronium with pancuronium in 80 anaesthetized surgical patients using mechanomyography and electromyography. Pancuronium 0.1 mg kg-1 or pipecuronium 0.07 mg kg-1 was given after induction of anaesthesia and neuromuscular block was adjusted to 75% t...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/74.4.410
更新日期:1995-04-01 00:00:00
abstract::Metoclopramide hastens emptying of the stomach. Since it may be given to patients before operation, the sedative and toxic effects of 10- and 20-mg does given i.m. were studied in patients and student volunteers. Saline and diazepam 10 mg were used as placebo and reference drugs. Neither dose of metoclopramide had as ...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/46.7.509
更新日期:1974-07-01 00:00:00
abstract::We report a case of improved cardiopulmonary exercise (CPX) test outcomes measured 48 h after initial CPX testing and immediately after alterations were made to the settings of a dual chamber, dual sensing pacemaker with exercise detection. The changes allowed successful abdominal surgery to be completed. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aet587
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:We developed a new neuromuscular transmission monitor, the compressomyograph (CMG, European patent number: EP 06018557.6, US patent number: US 60/824.541). This is the first preliminary report comparing neuromuscular block monitored by CMG and the Relaxometer mechanomyograph (MMG). METHODS:The two monitors ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aem379
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Plethysmographic variability index (PVI) is an accurate predictor of fluid responsiveness in mechanically ventilated patients. However, the site of measurement of the plethysmographic waveform impacts its morphology and its respiratory variation. The goal of this study was to investigate the ability of PVI t...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aer165
更新日期:2011-09-01 00:00:00
abstract::In order to evaluate the use of the post-tetanic count (PTC) method during repetitive administration of vecuronium, we studied 20 patients allocated randomly to one of two groups: 10 patients received droperidol-fentanyl anaesthesia (control group); 10 other patients were given droperidol-fentanyl anaesthesia modified...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/65.4.487
更新日期:1990-10-01 00:00:00
abstract:BACKGROUND:Early clot amplitudes measured on thromboelastometry (ROTEM®) predict maximum clot firmness (MCF) in adults. In this multicentre, retrospective study, we aimed to confirm the suspected relationship between early ROTEM® variables and MCF, in children undergoing cardiac or non-cardiac surgery. METHODS:4762 RO...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究
doi:10.1093/bja/aev369
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Arterial cannulation is a common anaesthetic procedure that can be challenging and time-consuming in small children. By visualizing the position of the radial artery, near-infrared vascular imaging systems (NIRVISs) might be of assistance in arterial cannulation. The present study evaluates the effectiveness...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aes193
更新日期:2012-09-01 00:00:00
abstract::Forty patients who had undergone coronary artery graft surgery and who required vasodilator therapy for postoperative hypertension were given infusions of either alfentanil or morphine together with bolus doses of midazolam for sedation and analgesia while ventilation was controlled artificially. Sodium nitroprusside ...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/61.6.669
更新日期:1988-12-01 00:00:00
abstract::The auditory steady state response (ASSR) is a sinusoidal evoked potential elicited by rapidly repeated auditory stimuli. The ASSR was recorded in eight patients during high-dose sufentanil anaesthesia for cardiac surgery in order to assess its usefulness as a measure of the level of consciousness. The electroencephal...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/66.6.683
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Some patients have features that indicate possible difficulty with direct laryngoscopy for tracheal intubation. Prediction of the likely outcome and selection of patients for an enhanced management algorithm would reduce the possible harm from failed intubation attempts. METHODS:Adult elective patients were...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2018.09.021
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Microalbuminuria, often referred to as the urinary albumin-creatinine ratio (ACR), is thought to be a reflection of increased capillary permeability associated with the systemic inflammatory response syndrome, and has been found to be predictive of outcome in several studies. Therefore, we explored the usefu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/ael211
更新日期:2006-10-01 00:00:00
abstract::Chronic pain affects ∼20% of the European population and is commoner in women, older people, and with relative deprivation. Its management in the community remains generally unsatisfactory, partly because of lack of evidence for effective interventions. Epidemiological study of chronic pain, through an understanding o...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aet123
更新日期:2013-07-01 00:00:00
abstract::Clevidipine is a new vascular-selective, calcium channel antagonist of the dihydropyridine type with an ester side chain susceptible to esterase metabolism. In healthy volunteers, it has high clearance (0.069 litres min-1 kg-1) with a small volume of distribution at steady state (0.19 litres kg-1). The half-lives of t...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/85.5.683
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:While volatile agents have been implicated in metastasis-enhancing effects on cancer cells, the effects of xenon are unknown. We investigated xenon- and sevoflurane-mediated effects on migration and expression of angiogenesis biomarkers in human breast adenocarcinoma cells. METHODS:MDA-MB-231 and MCF-7 cell...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeu191
更新日期:2014-07-01 00:00:00
abstract::On accout of its histamine releasing and ganglion blocking properties tubocurarine is known to have significant haemodynamic effects. Methylation of the compound produces metocurine and should decrease both histamine release and ganglionic blockade. The haemodynamic effects of these two compounds were compared in 10 m...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/51.11.1007
更新日期:1979-11-01 00:00:00