Abstract:
BACKGROUND:Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context. METHODS:After ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0-10) were obtained every 5 min for 15 min. RESULTS:The data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0-3 and 4-10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI. CONCLUSIONS:An SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-to-severe pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age. CLINICAL TRIAL REGISTRATION:ACTRN12617001475336.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Ledowski T,Schneider M,Gruenewald M,Goyal RK,Teo SR,Hruby Jdoi
10.1016/j.bja.2018.10.066subject
Has Abstractpub_date
2019-08-01 00:00:00pages
e328-e332issue
2eissn
0007-0912issn
1471-6771pii
S0007-0912(19)30094-7journal_volume
123pub_type
杂志文章abstract:BACKGROUND:Isoflurane and other volatile anaesthetics have a cardioprotective effect and limit myocardial infarct size to the same extent as ischaemic preconditioning. Phosphatidylinositol-3-kinase (PI3K) was found to play a key role in myocardial protection by ischaemic preconditioning. The aim of the present investig...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aei264
更新日期:2005-12-01 00:00:00
abstract::A double-blind crossover volunteer trial has been carried out to determine if oral doxapram reduces the respiratory depression caused by morphine 0.12 mg kg-1 i.m. Doxapram was given to the subjects 90 min before the morphine and significantly reduced the displacement of the ventilatory response to carbon dioxide caus...
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/62.2.159
更新日期:1989-02-01 00:00:00
abstract::The aim of this study was to find, using modern techniques, any histological differences in muscle biopsies between malignant hyperthermia (MH) susceptible (MHS), MH equivocal (MHE) and MH negative (MHN) patients. On the basis of the European MH contracture test carried out in 83 patients, 23 were shown to be MHS, nin...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/79.3.327
更新日期:1997-09-01 00:00:00
abstract::We describe an obstetric patient who developed incapacitating headache after inadvertent dural tap and was treated with repeated blood patching. She subsequently developed severe lumbar back pain which, after exclusion of suspected extradural abscess, was treated successfully with simple analgesics and physiotherapy. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/78.3.334
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:Investigators planning dose-response studies of neuromuscular blockers have rarely used a priori power analysis to determine the minimal sample size their protocols require. Institutional Review Boards and peer-reviewed journals now generally ask for this information. This study outlines a proposed method fo...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeq310
更新日期:2011-02-01 00:00:00
abstract::I.V. fluid therapy plays a fundamental role in the management of hospitalized patients. While the correct use of i.v. fluids can be lifesaving, recent literature demonstrates that fluid therapy is not without risks. Indeed, the use of certain types and volumes of fluid can increase the risk of harm, and even death, in...
journal_title:British journal of anaesthesia
pub_type: 共识发展会议,杂志文章,评审
doi:10.1093/bja/aeu300
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Ketamine-induced neuroapoptosis has been attributed to diverse stress-related mechanisms. Glycogen synthase kinase-3β (GSK-3β) is a multifunctional kinase that is active in neuronal development and linked to neurodegenerative disorders. We hypothesized that ketamine would enhance GSK-3β-induced neuroapopotos...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aet057
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:The use of lipid emulsions to reduce cardiac toxicity of local anaesthetics (LAs) has shown success in experimental studies and some clinical cases, and thus has been implemented in clinical practice. However, lipid treatment is usually given after the occurrence of neurological or cardiovascular symptoms of...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aet353
更新日期:2014-04-01 00:00:00
abstract::The pharmaceutical formulation of Althesin was shown to have a weak allergenic potential in the guinea pig maximization test. Alphadolone and alphaxalone acetate were found to be devoid of such potential, while the status of Cremophor EL remained equivocal. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/55.8.715
更新日期:1983-08-01 00:00:00
abstract::We have investigated the effect of interpleural morphine on postoperative pain and pulmonary function after thoracotomy. At the end of surgery, an interpleural catheter was inserted in 17 patients and, in a double-blind and randomized manner, either a bolus of morphine 2.5 mg interpleurally (i.p.) and normal saline i....
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/69.6.637
更新日期:1992-12-01 00:00:00
abstract::Arterial blood and expired gas samples were taken from 20 patients before operation and on the first day after upper abdominal surgery. After operation the patients were studied breathing air and also breathing 35% oxygen from a venturi-type mask. Preoperative Pao2 with age was exaggerated by operation. Pao2 after ope...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/47.4.491
更新日期:1975-04-01 00:00:00
abstract::A new type of intra-arterial oxygen electrode was evaluated. In 14 patients, undergoing one-lung ventilation for thoracic surgery, the electrode was inserted into the radial artery and changes in PaO2 were recorded continuously. Methods of improving PaO2 during one-lung ventilation were demonstrated. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.10.1005
更新日期:1976-10-01 00:00:00
abstract:BACKGROUND:Pain management in craniotomy patients is challenging, with mild-to-moderate pain intensity, moderate-to-high risk of postoperative nausea and vomiting (PONV), and potentially catastrophic consequences of analgesic-related side-effects. The aim of this study was to determine whether i.v. parecoxib administer...
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/aer223
更新日期:2011-09-01 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::Respiratory obstruction has been reported as a complication of carotid endarterectomy; the causes include traumatic mucosal oedema, direct tracheal compression by haematoma and oedema secondary to lymphatic and venous congestion. We report four cases of acute respiratory obstruction complicating carotid endarterectomy...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.1.156
更新日期:1996-01-01 00:00:00
abstract::We have examined the effects of morphine in auricular myocardium from non-failing and failing human hearts. In both preparations morphine induced inhibition. These responses were not antagonized by naloxone. Comparison of mean IC30 values obtained in non-failing (3.9 (SEM 0.2) x 10(-8) mol litre-1) and failing (5010 (...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.1.106
更新日期:1996-01-01 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::Eight patients with a history of failed tracheal intubation during pregnancy were investigated by x-ray laryngoscopy after delivery. Partial elevation of the epiglottis with no view of glottic structures was found in five patients who were therefore considered to still present difficulty. In each of these five patient...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/65.6.813
更新日期:1990-12-01 00:00:00
abstract::We have compared the effects of dexmedetomidine and propofol on endocrine, metabolic, inflammatory and cardiovascular responses in patients in the intensive care unit (ICU) after major surgery. Twenty patients who were expected to require 8 h of post-operative sedation and ventilation were allocated randomly to receiv...
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/86.5.650
更新日期:2001-05-01 00:00:00
abstract::In 1849 John Snow, already the leading anaesthetic practitioner and innovator of his day, made a historic contribution to the epidemiology of infectious disease by his famous study of the distribution of cholera around the area of Broad Street in London. We report on our experience as anaesthetists in a field hospital...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/75.6.810
更新日期:1995-12-01 00:00:00
abstract:BACKGROUND:Endothelial dysfunction might be involved in the development of cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH). METHODS:This prospective observational study of 48 SAH subjects and 23 control subjects examined associations between reactive hyperaemia index (RHI) measured by peripheral art...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aet331
更新日期:2014-02-01 00:00:00
abstract::Advances in cannabis research have paralleled developments in opioid pharmacology whereby a psychoactive plant extract has elucidated novel endogenous signalling systems with therapeutic significance. Cannabinoids (CBs) are chemical compounds derived from cannabis. The major psychotropic CB delta-9-tetrahydrocannabino...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
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更新日期:2008-07-01 00:00:00
abstract::We have studied 16 healthy volunteers whose lungs were preoxygenated six times each in order to assess the amount of room air entrained during tidal volume preoxygenation if a good seal is not maintained between the face mask and the face. With a fresh gas flow of 10 litre min-1, we found that using gravity alone to h...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/75.6.777
更新日期:1995-12-01 00:00:00
abstract::Alcuronium 0.16 mg kg-1 was used to provide neuromuscular blockade in patients with chronic renal failure undergoing renal transplantation. Relaxation was found to be adequate for intubation and surgery. There were minimal alterations to cardiovascular variables. The dose required was small, and complete reversal occu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/56.11.1229
更新日期:1984-11-01 00:00:00
abstract:BACKGROUND:Anaesthetic preconditioning (A_PreC) and postconditioning (A_PostC) both provide protection against ischaemia-reperfusion in the heart. However, post-ischaemic gene responses may differ between the two therapeutic strategies. METHODS:Isolated perfused rat hearts were exposed to 40 min test ischaemia followe...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aei155
更新日期:2005-08-01 00:00:00
abstract::We have studied the effects of flow and dobutamine on systemic haemodynamic variables, oxygen delivery (DO2) and oxygen consumption (VO2) in 20 patients during cardiopulmonary bypass (CPB) with mild hypothermia (34 degrees C). In a subgroup of seven patients, we also studied the effects on gastric microcirculatory blo...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.1.5
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:ROTEM(®)/TEG(®) (rotational thromboelastometry) assays appear to be useful for the treatment of bleeding trauma patients. However, data on the prevalence and impact of abnormal ROTEM(®) assays are scarce. METHODS:This is a prospective cohort study of blunt trauma patients (Injury Severity Score ≥15 or Glasg...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aer158
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:The therapeutic potential of cardiac μ-opioid receptors in ischaemia-reperfusion (I/R) injury during opioid-modulating diseases, such as heart failure, is unknown. We aimed to explore the changes of cardiac μ-opioid receptor expression during heart failure, and its role in opioid-induced cardioprotection. M...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2017.11.110
更新日期:2018-07-01 00:00:00
abstract::We have studied the effects of alfentanil administered intrathecally on somatosympathetic reflexes evoked by stimulation of radial and tibial nerves in 10 anaesthetized and paralysed dogs. In five animals, alfentanil was administered in doses of 100, 100, 200 and 400 micrograms in 0.8 ml and 800 micrograms in 1.6 ml p...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/68.5.503
更新日期:1992-05-01 00:00:00
abstract::The relative analgesic efficacy and side-effect profile of peripheral nerve blockade (PNB) techniques compared with lumbar epidural analgesia for major knee surgery is unclear. We undertook a systematic review and meta-analysis of all randomized trials comparing epidural analgesia with PNB for major knee surgery. Eigh...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1093/bja/aem373
更新日期:2008-02-01 00:00:00