BIS-guided anaesthesia can reduce the risk of intraoperative awareness in surgical patients at high risk for awareness in comparison to using clinical signs as a guide for anaesthetic depth. BIS-guided anaesthesia and ETAG-guided anaesthesia may be equivalent in protection against intraoperative awareness but the evidence for this is inconclusive. In addition, anaesthesia guided by BIS kept within the recommended range improves anaesthetic delivery and postoperative recovery from relatively deep anaesthesia.

Background and Goal of Study:The use of hypotonic intravenous fluids has been associated with more than 50 international case reports of death or neurological injury in children. In 2003 the Royal College of Anaesthetists warned of the risk of iatrogenic hyponatraemia and water overload developing after the use of sodium chloride 0.18% with glucose 4% in children. A followup survey found less than half of consultant anaesthetists had been aware of this warning. 1 Our audit looked at whether anaesthetists' fluid prescriptions intraoperatively and postoperatively reflected these concerns in our department. Materials and Methods:The audit examined the fluid administration in paediatric operations over a 4 month period. Data collected included the age and weight of the child, the volume, rate and type of fluid prescribed intraoperatively and postoperatively, whether there was any estimate of blood or fluid loss, and whether capillary blood sugar was recorded.We also recorded the current locations of sodium chloride 0.18% with glucose 4%. Results and Discussions: Over the 4 month period, 35 patients received intraoperative fluids: none had a capillary blood sugar recorded and only 1 had an estimate of blood or fluid loss. 31 were given isotonic solutions, at volumes between 3-34 ml/kg. 4 were given hypotonic solutions (2 at 10-20 ml/kg, 2 at greater volumes).Only 17 patients were prescribed postoperative fluids: 13 were given isotonic solutions, of which only 4 were prescribed according to the Holliday and Segar formula. 2 The majority were prescribed at greater rates. 4 were given hypotonic fluids, 1 at the predicted rate, 2 at a greater rate and 1 at almost half the calculated rate. 2 Sodium chloride 0.18% with glucose 4% solution was freely available in all clinical areas. Conclusion(s):There is no restriction in the availability of sodium chloride 0.18% with glucose 4% solution. The majority of paediatric patients are given isotonic fluid intraoperatively. However, despite the concerns about hyponatraemia, post-operatively the majority are being prescribed either hypotonic or excessive rates of fluid.

Anaesthesia guided by BIS within the recommended range (40 to 60) could improve anaesthetic delivery and postoperative recovery from relatively deep anaesthesia. In addition, BIS-guided anaesthesia has a significant impact on reduction of the incidence of intraoperative recall in surgical patients with high risk of awareness.

No abstract

No abstract

Background: Ilioinguinal/iliohypogastric nerve block is commonly performed to control postherniotomy pain. The posterior quadratus lumborum block has been recently described as an effective analgesic technique for pediatric low abdominal surgery. No data were found regarding the use of posterior quadratus lumborum block in comparison with the traditional ilioinguinal/iliohypogastric nerve block in pediatric inguinal surgery. Aim: This randomized assessor-blinded study compared postoperative analgesic effects between ultrasound-guided posterior quadratus lumborum block and ilioinguinal/iliohypogastric nerve block in pediatric inguinal herniotomy. Methods: One-to seven-year-old children scheduled for unilateral open herniotomy were randomly assigned to receive either ultrasound-guided posterior quadratus lumborum block with 0.25% bupivacaine 0.5 mL/kg or ultrasound-guided ilioinguinal/iliohypogastric nerve block with 0.25% bupivacaine 0.2 mL/kg after induction of general anesthesia. The primary outcome was the proportion of patients who received postoperative oral acetaminophen. The required fentanyl in the recovery room, 24-hour acetaminophen consumption, success rate of regional blocks, block performance data, block-related complications, postoperative pain intensity, and parental satisfaction were assessed. Results: This study included 40 patients after excluding four cases who were ineligible. The number of patients who required postoperative oral acetaminophen was significantly lower in the posterior quadratus lumborum block group (15.8% vs 52.6%;OR: 5.9; 95% CI: 1.3, 27.3; P = .022). The pain scores at 30 minutes, 1, 2, 6, 12, and 24 hours were similar between groups. There was no evidence of between-group differences in block performance time, the number of needle passes, block-related complications, and parental satisfaction.

No abstract

Background Respiratory complications are some of the most common complications following thoracic surgery and can lead to higher perioperative morbidity and mortality. The purpose of this study was to develop a simple clinical score for prediction of respiratory complications after thoracic surgery, and determine the internal validity. Methods In this retrospective cohort study, all consecutive patients were aged 18 years and over and undergoing non-cardiac thoracic surgery at a tertiary-care university hospital. Respiratory complications included bronchospasm, atelectasis, pneumonia, respiratory failure, and adult respiratory distress syndrome within 30 days of surgery or before discharge. Results A total of 1488 patients were included over a 7-year period, and 15.8% (235 of 1488 patients) developed respiratory complications. The significant predictors of respiratory complications were chronic obstructive pulmonary disease, American Society of Anesthesiologist physical status ≥ 3, right-sided surgery, duration of surgery longer than 180 min, preoperative arterial oxygen saturation on room air < 96%, and open thoracotomy. The area under receiving operating characteristic curve was 0.78 (95% confidence interval: 0.75–0.82) and 0.76 (95% confidence interval: 0.70–0.83) for the derivation and validation cohorts, respectively. The model was well calibrated with a Hosmer-Lemeshow goodness-of-fit of 7.32 ( p = 0.293). Conclusions This study developed and internally validated a simple clinical risk score for prediction of respiratory complications following thoracic surgery. This score can be used to stratify high-risk patients, address modifiable risk factors for respiratory complications, and provide preventive strategies for improving postoperative outcomes.