Perioperative Outcomes After Preoperative Epidural Analgesia in Patients with Hip Fracture Undergoing Surgical Repair: A Systematic Review.

Objective: To examine the effectiveness and safety of epidural analgesia in the presurgical period in patients with hip fracture undergoing surgical repair.

Design: Systematic review.

Methods: The study protocol was registered with the PROSPERO systematic reviews registry with the (identifier CRD42019140396).

The Effect of Low-Dose Intraoperative Ketamine on Closed-Loop-Controlled General Anesthesia: A Randomized Controlled Equivalence Trial.

Background: Closed-loop control of propofol-remifentanil anesthesia using the processed electroencephalography depth-of-hypnosis index provided by the NeuroSENSE monitor (WAVCNS) has been previously described. The purpose of this placebo-controlled study was to evaluate the performance (percentage time within ±10 units of the setpoint during the maintenance of anesthesia) of a closed-loop propofol-remifentanil controller during induction and maintenance of anesthesia in the presence of a low dose of ketamine.

Methods: Following ethical approval and informed consent, American Society of Anesthesiologist (ASA) physical status I-II patients aged 19-54 years, scheduled for elective orthopedic surgery requiring general anesthesia for >60 minutes duration, were enrolled in a double-blind randomized, placebo-controlled, 2-group equivalence trial.

Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners.

Background: Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach.

The effect of ketamine on depth of hypnosis indices during total intravenous anesthesia-a comparative study using a novel electroencephalography case replay system.

Ketamine may affect the reliability of electroencephalographic (EEG) depth-of-hypnosis indices as it affects power in high-frequency EEG components. The purpose of this study was to compare the effects of ketamine on three commonly-used depth-of-hypnosis indices by extending our EEG simulator to allow replay of previously-recorded EEG. Secondary analysis of previously-collected data from a randomized controlled trial of intravenous anesthesia with ketamine: Group 0.

Effect of ketamine on the NeuroSENSE WAV during propofol anesthesia; a randomized feasibility trial.

Dose-dependent effects of ketamine on processed electroencephalographic depth-of-hypnosis indices have been reported. Limited data are available for the NeuroSENSE WAV index. Our aim was to establish the feasibility of closed-loop propofol-remifentanil anesthesia guided by the WAV index in the presence of an analgesic dose of ketamine.

Slated versus actual operating room entry time in a British Columbia health authority.

Purpose: To determine how frequently the published operating room (OR) schedule of case start times correlated with the actual OR entry time for elective cases in the Fraser Health Authority (FHA) in British Columbia, Canada. Society guidelines recommend periods of fasting of two hours prior to the induction of general anesthesia, but patients frequently end up fasting much longer. This review aimed to determine when patients arrive in the OR-either earlier than their scheduled time or later.

Zero-heat-flux core temperature monitoring system: an observational secondary analysis to evaluate agreement with naso-/oropharyngeal probe during anesthesia.

General anesthesia impairs thermoregulation and contributes to perioperative hypothermia; core body temperature monitoring is recommended during surgical procedures lasting > 30 min. Zero-heat-flux core body temperature measurement systems enable continuous non-invasive perioperative monitoring. During a previous trial evaluating the benefits of preoperative forced-air warming, intraoperative temperatures were measured with both a zero-heat-flux sensor and a standard naso-/oropharyngeal temperature probe.

Evaluating NeuroSENSE for assessing depth of hypnosis during desflurane anesthesia: an adaptive, randomized-controlled trial.

Purpose: Processed electroencephalography (EEG) monitors support depth-of-hypnosis assessment during anesthesia. This randomized-controlled trial investigated the performance of the NeuroSENSE electroencephalography (EEG) monitor to determine whether its wavelet anesthetic value for central nervous system (WAV) index distinguishes consciousness from unconsciousness during induction of anesthesia (as assessed by the anesthesiologist) and emergence from anesthesia (indicated by patient responsiveness), and whether it correlates with changes in desflurane minimum alveolar concentration (MAC) during maintenance of anesthesia.

Methods: EEG was collected using a fronto-temporal bilateral montage.

Effect of preoperative warming on intraoperative hypothermia: a randomized-controlled trial.

Purpose: The purpose of this study was to evaluate the effects of preoperative forced-air warming on intraoperative hypothermia.

Methods: In this randomized-controlled trial, adult patients scheduled for elective, non-cardiac surgery under general anesthesia were stratified by scheduled surgical duration (< 2.5 hr or ≥ 2.

Design and Evaluation of a Closed-Loop Anesthesia System With Robust Control and Safety System.

Background: Closed-loop control of anesthesia involves continual adjustment of drug infusion rates according to measured clinical effect. The NeuroSENSE monitor provides an electroencephalographic measure of depth of hypnosis (wavelet-based anesthetic value for central nervous system monitoring [WAVCNS]). It has previously been used as feedback for closed-loop control of propofol, in a system designed using robust control engineering principles, which implements features specifically designed to ensure patient safety.

Closed-Loop Control of Total Intravenous Anesthesia During Significant Intraoperative Blood Loss: A Case Report.

Closed-loop control of anesthesia based on continuous feedback from processed electroencephalography adjusts drug dosing to target a desired depth of hypnosis during dynamic clinical circumstances, freeing the anesthesiologist to focus on more complex tasks. We describe a case of closed-loop control of total intravenous anesthesia in which a sudden loss of blood required immediate intervention. This case illustrates that closed-loop control of drug delivery maintained an appropriate depth of hypnosis during a rapidly changing surgical situation, and that processed electroencephalography may be a useful adjunct indicator for cerebral hypoperfusion.

Nitrous oxide and serious morbidity and mortality in the POISE trial.

Background: In this post hoc subanalysis of the Perioperative Ischemic Evaluation (POISE) trial, we sought to determine whether nitrous oxide was associated with the primary composite outcome of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal cardiac arrest within 30 days of randomization.

Methods: The POISE trial of perioperative β-blockade was undertaken in 8351 patients. Nitrous oxide anesthesia was defined as the coadministration of nitrous oxide in patients receiving general anesthesia, with or without additional neuraxial blockade or peripheral nerve blockade.

A survey of British Columbia anesthesiologists on a provincial critical incident reporting program.

Purpose: To determine why British Columbia's anesthesiologists have not actively participated in a provincial Critical Incident Reporting Service by submitting reports of critical incidents experienced in their practice.

Methods: An email and postal mail survey of BC anesthesiologists was undertaken, proposing a variety of reasons why critical incidents may not be reported to the Service.

Results: 207 responses were received from 368 specialist and general practitioner anesthesiologists.