Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens

BACKGROUND: General anaesthesia should prevent patients from experiencing surgery, defined as connected consciousness. The isolated forearm technique (IFT) is the current gold standard for connected consciousness monitoring. We evaluated the efficacy of different anaesthesia regimens in preventing IFT responses. METHODS: We conducted a systematic review with meta-analysis of studies evaluating IFT in adults. Proportions of IFT-positive patients were compared for inhalational versus intravenous anaesthesia and anaesthesia brain monitor (ABM)-guided versus non-ABM-guided. RESULTS: Of 1131 patients in 22 studies, 393 (34.8%) had an IFT response during induction or maintenance. IFT-positive patients were less frequent during induction (19.7% [95% CI, 17.5-22.1]) than during maintenance (31.2% [95% CI, 27.8-34.8]). Proportions of IFT-positive patients during induction and maintenance were similar for inhalational (0.51 [95% CI, 0.38-0.65]) and intravenous (0.52 [95% CI, 0.26-0.77]) anaesthesia, but during maintenance were lower with inhalational (0.18 [95% CI, 0.08-0.38]) than with intravenous (0.48 [95% CI, 0.24-0.73]) anaesthesia. Proportions of IFT-positive patients during induction and maintenance were not significantly different for ABM-guided (0.64 [95% CI, 0.39-0.83]) and non-ABM-guided (0.48 [95% CI, 0.34-0.62]) anaesthesia but during maintenance were lower with non-ABM-guided (0.19 [95% CI, 0.09-0.37]) than with ABM-guided (0.57 [95% CI, 0.34-0.77]). Proportions of IFT-positive patients decreased significantly with increasing age and premedication use. Of the 34 anaesthesia regimens, 16 were inadequate. Studies had low methodological quality (only seven randomised controlled trials) and significant heterogeneity. CONCLUSIONS: Standard general anaesthesia regimens might not prevent connected consciousness. More accurate anaesthesia brain monitor methodology to reduce the likelihood of connected consciousness is desirable

Ephedrine requirements are reduced during spinal anaesthesia for caesarean section in preeclampsia

Part of the Portfolio Thesis by Geoffrey H. Sharwood-Smith: The inferior vena caval compression theory of hypotension in obstetric spinal anaesthesia: studies in normal and preeclamptic pregnancy, a literature review and revision of fundamental concepts, available at http://hdl.handle.net/10023/1815Background: Despite controversy over the haemodynamically safest blockade for caesarean section in women with severe preeclampsia, an increasing number of anaesthetists now opt for spinal anaesthesia. In a previous study we found that spinal compared to epidural anaesthesia offered an equally safe but more effective option for these patients. The current study was designed to compare the hypotension induced by spinal anaesthesia, as measured by ephedrine requirement, between 20 normotensive and 20 severely preeclamptic but haemodynamically stabilised women. Method: Standardised spinal anaesthesia was instituted and ephedrine was given in boluses of 6 mg if the systolic pressure fell >20% from the baseline, or if the patient exhibited symptoms of hypotension. Results: The mean ephedrine requirement of the normotensive group (27.9 ± 11.6 mg) was significantly greater (P < 0.01) than that of the preeclamptic group (16.4 ± 15.0 mg). Conclusion: This suggests that the hypotension induced by spinal anaesthesia in women with severe but haemodynamically stabilised preeclampsia, is less than that of normotensive patients.Publisher PD

Effects of extracts of dried seeds of Toloache, Datura innoxia as anaesthesia on the African catfish Clarias gariepinus fingerlings

The effects of crude extract, pure extract, aqueous, fraction of pure and lipid fraction of pure extract of dried seeds of toloache. Datura innoxia as anaesthesia on the African catfish. Clarias gariepinus fingerlings were studied. The fish were exposed to various doses of the extract in aquaria tanks and the time taken for each fish to reach anaesthesia was recorded. The fish were anaesthetized up to 3.00g/l fingerlings reached anaesthesia is significantly (P0.05) better anaesthetic on the fish. The control produced no observable anaesthetic effect on the fish within three hours. This suggests that the anaesthetizing active ingredent resided in the lipid fraction. All fish recovered from anaesthesia, swam and fed actively and no mortality was observed throughout the exposure period and thereafter. It is therefore recommended for use on C. gariepinus fingerling

The applications of sub-Tenon's anaesthesia for canine ophthalmic surgery : a thesis presented in fulfilment of the requirements for the degree of Master of Veterinary Science (MVSc) at Massey University, Manawatu, New Zealand

Sub-Tenon's anaesthesia is an indispensable anaesthetic technique in human ophthalmic surgery. It produces highly effective regional anaesthesia and has a significantly lower complication rate than the previously used peribulbar and retrobulbar injections. Although this technique has potential application to veterinary ophthalmology it has not yet been reported in clinical cases. This thesis reviews the literature that references local anaesthesia for ocular surgery in human and veterinary ophthalmology. A sub-Tenon's block technique that was specifically developed for use in dogs is also described. This technique is assessed with a prospective controlled clinical study testing this technique across a variety of ocular surgeries including enucleation, intrascleral prosthesis, keratectomy with a third eyelid flap and cataract surgery. The effect of sub-Tenon's anaesthesia on specific parameters was recorded and compared to the controls such as; globe position and rotation, pupillary dilation, general anaesthetic monitoring parameters, intraocular pressure, vitreal expansion and post-operative pain scores. Analysis of these parameters has indicated that sub-Tenon's anaesthesia was an effective option for controlling post-operative pain when used in conjunction with systemic analgesics and was an excellent alternative to systemic neuromuscular blockade for canine cataract surgery

GALA: an international multicentre randomised trial comparing general anaesthesia versus local anaesthesia for carotid surgery

Background: Patients who have severe narrowing at or near the origin of the internal carotid artery as a result of atherosclerosis have a high risk of ischaemic stroke ipsilateral to the arterial lesion. Previous trials have shown that carotid endarterectomy improves long-term outcomes, particularly when performed soon after a prior transient ischaemic attack or mild ischaemic stroke. However, complications may occur during or soon after surgery, the most serious of which is stroke, which can be fatal. It has been suggested that performing the operation under local anaesthesia, rather than general anaesthesia, may be safer. Therefore, a prospective, randomised trial of local versus general anaesthesia for carotid endarterectomy was proposed to determine whether type of anaesthesia influences peri-operative morbidity and mortality, quality of life and longer term outcome in terms of stroke-free survival. Methods/design: A two-arm, parallel group, multicentre randomised controlled trial with a recruitment target of 5000 patients. For entry into the study, in the opinion of the responsible clinician, the patient requiring an endarterectomy must be suitable for either local or general anaesthesia, and have no clear indication for either type. All patients with symptomatic or asymptomatic internal carotid stenosis for whom open surgery is advised are eligible. There is no upper age limit. Exclusion criteria are: no informed consent; definite preference for local or general anaesthetic by the clinician or patient; patient unlikely to be able to co-operate with awake testing during local anaesthesia; patient requiring simultaneous bilateral carotid endarterectomy; carotid endarterectomy combined with another operation such as coronary bypass surgery; and, the patient has been randomised into the trial previously. Patients are randomised to local or general anaesthesia by the central trial office. The primary outcome is the proportion of patients alive, stroke free ( including retinal infarction) and without myocardial infarction 30 days post-surgery. Secondary outcomes include the proportion of patients alive and stroke free at one year; health related quality of life at 30 days; surgical adverse events, re-operation and re-admission rates; the relative cost of the two methods of anaesthesia; length of stay and intensive and high dependency bed occupancy

Resource efficiency and economic implications of alternatives to surgical castration without anaesthesia

This paper presents an analysis of the economic implications of alternative methods to surgical castration without anaesthesia. Detailed research results on the economic implications of four different alternatives are reported. castration with local anaesthesia, castration with general anaesthesia, immunocastration and raising entire males. The first three alternatives have been assessed for their impact on pig production costs in the most important pig-producing Member States of the EU. The findings on castration with anaesthesia show that cost differences among farms increase if the anaesthesia cannot be administered by farmers and when the veterinarian has to be called to perform it. The cost of veterinarian service largely affects the total average costs, making this solution economically less feasible in small-scale pig farms. In all other farms, the impact on production costs of local anaesthesia is however limited and does not exceed 1 (sic)ct per kg. General anaesthesia administered by inhalation or injection of Ketamin in combination with a sedative (Azaperone, Midazolan) is more expensive. These costs depend heavily on farm size, as the inhalation equipment has to be depreciated on the largest number of pigs possible. The overall costs of immunocastration - including the cost of the work load for the farmer - has to be evaluated against the potential benefits derived from higher daily weight gain and feed efficiency in comparison with surgical castrates. The economic feasibility of this practice will finally depend on the price of the vaccine and on consumer acceptance of immunocastration, The improvement in feed efficiency may compensate almost entirely for the cost of vaccination. The main advantages linked to raising entire males are due to the higher efficiency of feed conversion, to the better growth rate and to the higher leanness of carcass. A higher risk of boar taint on the slaughter line has to be accounted for Raising entire males should not generate more than 2.5% of boar taint among slaughter pigs, in order to maintain the considerable economic benefits of better feed efficiency of entire males with respect to castrates

Anaesthesia Fluid Detection in 3D Contrast Enhanced Ultrasound Image

Ultrasound medical image has disadvantage on displaying anaesthesia fluid due to its low intensity. Using contrast agent to enhance brightness of fluid area makes it possible to extract fluid area from acquired 3D image. This paper proposes an easy to implement approach to detect anaesthesia fluid. The approach will slice 3D image into arrays of 2D image, remove low intensities area from image, reconstruct fluid area to its original size, and combine 2D fluid area images into 3D visualization. The purpose of this paper is to help anaesthetist to confirm whether the operation is success and for further studying on how anaesthesia fluid spread

Chaos-modified detrended moving average methodology for monitoring the depth of anaesthesia

This paper proposes a new method to monitor the depth of anaesthesia (DoA) based on the EEG signal. This approach firstly uses discrete wavelet transform (DWT) to to remove the spikes and the low frequency noise from raw EEG signals. After de-noising the EEG signals, the modified Hurst parameter is proposed with two new indices (CDoA and CsDoA), to estimate the anaesthesia states of the patients. To reduce the fluctuation of the new DoA index, a combination of Modified Chaos and Modifying Detrended Moving Average is used (MC-DMA). Analyses of variance (ANOVA) for C-MDMA and BIS distributions are presented The results indicate that the C-MDMA distributions at each anaesthesia state level are significantly different and the C-MDMA can distinguish five depths of anaesthesia. Compared with BIS trends, MC-DMA trend is close to BIS trend covering the whole scale from 100 to 0 with a full recording time

An improved chaos method for monitoring the depth of anaesthesia

This paper proposed a new method to monitor the depth of anaesthesia (DoA) by modifying the Hurst parameters in Chaos method. Two new indices (CDoA and CsDoA) are proposed to estimate the anaesthesia states of patients. In order to reduce the fluctuation of CDoA and CsDoA trends, the Chaos and Modified Detrended Average methods (C-MDMA) are combined together. Compared with Bispectrum (BIS) index, CDoA, the CsDoA and C-MDMA trends are close to the BIS trend in the whole scale from 100 to 0 with a full recording time

A comparison of medetomidine and its active enantiomer dexmedetomidine when administered with ketamine in mice

Medetomidine-ketamine (MK) and dexmedetomidine-ketamine (DK) are widely used to provide general anaesthesia in laboratory animals, but have not been compared directly in many of these species, including rodents. This study aimed to compare the onset and depth of anaesthesia, and changes in vital signs, after intraperitoneal (IP) or subcutaneous (SC) administration of ketamine (75 mg kg-1) combined with medetomidine (1 mg kg-1) or dexmedetomidine (0.5 mg kg-1) using a randomised semi-crossover design with >= 48 hours between treatments in 10 male and 10 female mice. Each mouse was anaesthetised twice using the same administration route (IP or SC): once with each drug-ketamine combination. Anaesthetised mice were monitored on a heating pad without supplemental oxygen for 89 minutes; atipamezole was administered for reversal. The times that the righting reflex was lost post-injection and returned post-reversal were analysed using general linear models. Tail-pinch and pedal reflexes were examined using binomial generalized linear models. Pulse rate (PR), respiratory rate (fr), and arterial haemoglobin saturation (SpO2) were compared using generalized additive mixed models. There were no significant differences among treatments for the times taken for loss and return of the righting reflex, or response of the tail-pinch reflex. The pedal withdrawal reflex was abolished more frequently with MK than DK over time (P = 0.021). The response of PR and SpO2 were similar among treatments, but fr was significantly higher with MK than DK (P <= 0.0005). Markedly low SpO2 concentrations occurred within 5 minutes post-injection (83.8 +/- 6.7 %) in all treatment groups and were most severe after 89 minutes lapsed (66.7 +/- 7.5 %). No statistical differences were detected in regards to administration route (P <= 0.94). This study failed to demonstrate clinical advantages of the enantiomer dexmedetomidine over medetomidine when combined with ketamine to produce general anaesthesia in mice. At the doses administered, deep surgical anaesthesia was not consistently produced with either combination; therefore, anaesthetic depth must be assessed before performing surgical procedures. Supplemental oxygen should always be provided during anaesthesia to prevent hypoxaemia