[New Approaches in Perioperative Algesimetry].

The measurement of anaesthetic depth and muscle relaxation have been routine procedures during general anaesthesia for years. Quantification of intraoperative nociception, on the other hand, is still largely impossible. Various methods have been tested and commercialised for more than 10 years.

Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients.

Background: Residual neuromuscular block is associated with an increased risk of postoperative pulmonary complications in retrospective studies. The aim of our study was to investigate prospectively the incidence of postoperative pulmonary complications after reversal with either sugammadex (SUG) or neostigmine (NEO) in high-risk older patients.

Methods: We randomly allocated 180 older patients with significant morbidity (ASA physical status 3) ≥75 yr old to reversal of rocuronium with either SUG or NEO.

Deep neuromuscular paralysis during hip arthroscopic surgery: influence on perineal tissue pressures and hip joint width.

Pudendal nerve injuries are not an uncommon side effect of patient positioning on a traction table, and muscle relaxation has been suggested to mitigate this risk by reducing pressure on the perineum. A total of 40 patients scheduled for hip arthroscopic surgery under general anaesthesia were recruited. After induction of anaesthesia, pressures on the perineum were measured in 20 subjects by means of an ultra-thin pressure sensor mat wrapped around the perineal post.

Nociception level index: do intra-operative values allow the prediction of acute postoperative pain?

Nociception Level Index (NOL) guided analgesia has previously been found to correlate with noxious stimuli during surgery. It was aim of this study to investigate the relationship between intra-operative NOL and acute postoperative pain. After IRB approval, 80 patients scheduled for non-emergency surgery were enrolled.

Predicting acute postoperative pain by the Qnox score at the end of surgery: a prospective observational study.

Background: The QNox score (Quantium Medical S.L., distributed by Fresenius Kabi) has recently been introduced as a tool to quantify intraoperative analgesia.

Objective monitoring of nociception: a review of current commercial solutions.

Nociception, in contrast to pain, is not a subjective feeling, but the physiological encoding and processing of nociceptive stimuli. However, monitoring nociception remains a challenge in attempts to lower the incidence of acute postoperative pain and the move towards a more automated approach to analgesia and anaesthesia. To date, several commercialised devices promise a more accurate reflection of nociception than the traditionally used vital signs, blood pressure and heart rate.

Cheaper drugs and techniques to fulfill chief executive officer perspectives - any choices?

Purpose Of Review: Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products.

Recent Findings: Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change - even if this may seem to come at a higher cost.

Effects of muscle relaxants on ischaemia damage in skeletal muscle.

Muscle ischaemia is frequently induced intraoperatively by i.e. a surgical tourniquet or during the re-grafting phase of a free muscle transplant.

Current Trends in Neuromuscular Blockade, Management, and Monitoring amongst Singaporean Anaesthetists.

. This survey aimed to investigate the attitudes/practice pertaining the use, management, and monitoring of neuromuscular blockade amongst Singaporean anaesthetists. .

Muscle Relaxation in Laparoscopic Surgery: What is the Evidence for Improved Operating Conditions and Patient Outcome? A Brief Review of the Literature.

When neuromuscular blocking agents (NMBA) were introduced into clinical practice in 1942, the event was called the "second revolution in anesthesia." Despite some significant side effects, NMBAs have remained in the anesthetists' repertoire, not at least because muscle relaxation has been claimed to allow or facilitate many surgical procedures. Aim of this literature review was to investigate the evidence for the use of NMBA as well as the optimum depth of neuromuscular blockade during laparoscopic surgery.

Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children's Hospital.

Purpose. Residual neuromuscular blockade (RNMB) is known to be a significant but frequently overlooked complication after the use of neuromuscular blocking agents (NMBA). Aim of this prospective audit was to investigate the incidence and severity of RNMB at our Australian tertiary pediatric center.

Corrigendum: Effect of muscle relaxation on the oxygenation of human skeletal muscle: a prospective in-vivo experiment using an isolated forearm technique.

[This corrects the article on p. 13 in vol. 68, PMID: 25664149.

Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice.

Sugammadex was introduced to Royal Perth Hospital in early 2011 without access restriction. Two departmental audits (26-page online survey and 1-week in-theatre snapshot audit) were undertaken to investigate the change of beliefs and clinical practice related to the use of neuromuscular blocking agents at the Royal Perth Hospital since this introduction. Results were compared with data from 2011.

Effect of muscle relaxation on the oxygenation of human skeletal muscle: a prospective in-vivo experiment using an isolated forearm technique.

Background: Total oxygen consumption has been found to be reduced under deep neuromuscular blockade due to a lower rate of metabolism of skeletal muscles. However, the magnitude of this effect in individual muscles has not been investigated. Thus the aim of this study was to compare the oxygenation of paralyzed versus non-paralyzed forearm muscle under tourniquet-provoked ischemia.

Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: sugammadex, neostigmine or no reversal.

Background: Postoperative residual neuromuscular blockade (RNMB) is associated with significant morbidity.

Objective: The aim of this retrospective data analysis was to investigate the influence of the method of RNMB reversal on postoperative outcome.

Setting: Tertiary teaching hospital in Western Australia.

Acute effects of red wine on cytochrome P450 eicosanoids and blood pressure in men.

Objective: The vasodilation accompanying acute alcohol ingestion is hard to reconcile with the strong evidence linking chronic alcohol consumption with hypertension. Cytochrome P450 (CYP450) eicosanoids derived from arachidonic acid include vasodilator epoxyeicosatrienoic acids (EETs) and the vasoconstrictor 20-hydroxyeicosatrienoic acid (20-HETE). This study aimed to examine the relationship between CYP450 eicosanoids and blood pressure (BP), and compared the effect of single session of drinking red wine with de-alcoholized red wine (DRW) or water over 24 h.

Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome.

Background: The aim of this prospective audit was to investigate clinical practice related to muscle relaxant reversal and the impact made by the recent introduction of sugammadex on patient outcome at a tertiary teaching hospital.

Methods: Data from all patients intubated at our institution during two epochs of seven consecutive days each was collected prospectively. Directly prior to extubation, the train-of-four (TOF) ratio was assessed quantitatively by an independent observer.

Effects of acute postoperative pain on catecholamine plasma levels, hemodynamic parameters, and cardiac autonomic control.

Postoperative pain is often stated to be a significant contributor to a sympathetic stress response after surgery. However, hardly any evidence has been published to support this assumption. Hence it was the aim of this trial to investigate the relationship between postoperative pain and hemodynamic, endocrine, and autonomic parameters.

Skin conductance for monitoring of acute pain in adult postoperative patients: influence of electrode surface area and sampling time.

Aim of this prospective randomized study was to determine the influence of the electrode surface area and sampling time on the accuracy of the number of fluctuations in skin conductance per second to distinguish different states of acute pain. These methodological issues have been previously suggested as an explanation for contradictory data related to the accuracy of the skin conductance monitor. A total of 541 pain ratings on a numeric rating scale (0-10) were obtained from 120 adult postoperative patients.

The influence of age and sex on the relationship between heart rate variability, haemodynamic variables and subjective measures of acute post-operative pain.

Background And Objective: Both skin conductance and surgical stress index have been proposed as useful means of assessing pain. Both methods are based on the assessment of the sympathovagal balance, which, according to reports, is influenced by age and sex, and currently neither of the assessments take these factors into account. The aim of this study was to determine the relationship between age, sex, magnitude of acute post-operative pain and haemodynamic and autonomic changes.

Vitamin E supplementation and hepatic drug metabolism in humans.

Meta-analyses studies suggest that high-dose vitamin E may be associated with increased mortality in some populations. Vitamin E may increase the production of CYP3A4 in the liver, and this could lead to an increase in drug metabolism, potentially lowering the efficacy of therapeutic drugs. We hypothesized that upregulation of CYP3A4 by alpha-tocopherol (alpha-TOH) would decrease the plasma concentration of the CYP3A4 substrate midazolam.

Monitoring electrical skin conductance: a tool for the assessment of postoperative pain in children?

Background: Monitoring changes in electrical skin conductance has been described as a potentially useful tool for the detection of acute pain in adults. The aim of this study was to test the method in pediatric patients.

Methods: A total of 180 postoperative pediatric patients aged 1-16 yr were included in this prospective, blinded observational study.