An Unexplained Secrecy Towards Saracatinib Revealed
  • There is also a distinct possibility that such response to command could have occurred during painful parts of the procedure, since not only were the doses of propofol and remifentanil?low, but epidurals were not inserted in all patients and no mention is made as to whether or not the epidurals were tested for efficacy CX-5461 research buy before induction. We are most surprised, and somewhat relieved, that more patients did not recall intra-operative events. It is widely accepted that, in order to accurately detect awareness with recall, patients should have follow-up interviews at three and seven days postoperatively [2]. Perhaps if this had been done, the rate of awareness may have been even higher. The recent National Institute for Health and Care Excellence (NICE) guidelines relating to depth of anaesthesia monitors [3] specifically mention that training needs to be undertaken to ensure that users fully understand their strengths and weaknesses. If a manuscript like this is to contribute to our understanding of this technology, it must explain why a technique that involved the use of a neuromuscular blocking drug and a surgical field distant from Saracatinib the BIS sensor could result in such consistently high (30%) electromyelogram activity shown in the two detailed cases presented. Similarly, it should be pointed out that the large BIS variability seen in the study figures (known as ��trend spikes��) should warn the anaesthetist that the underlying opioid dose is relatively low, and a climbing/rising BIS trace seen in Fig. 3 should?be addressed immediately. The study protocol, Forskolin clinical trial however, involved waiting a little longer to see if the patient woke further and had a ��hand squeezing conversation�� with the attending clinician. This, we feel, is unacceptable since, if light anaesthesia is a possibility, a cause should be sought (e.g. inadequate analgesia) and the anaesthetic adjusted accordingly, without delay. We feel that Russell should have made it clear in his discussion that accepting a BIS value > 60 is not to be encouraged unless the patient is haemodynamically stable and the anaesthetic concentrations are clinically adequate (which is questionable in this study when one example shows a propofol target concentration < 2?��g.ml?1). The isolated forearm technique, if used for its original purpose and not simply to test the boundaries of probability, is undoubtedly the gold standard for monitoring wakefulness under anaesthesia; it is, however, unlikely ever to be widely adopted into routine clinical practice. As routine users of intra-operative BIS monitoring, we would urge all readers not to take the findings of Russell's study in isolation. He has correctly concluded that patients may respond to command with a BIS value < 60.

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