Clinical Research Directory

Exploration of Appropriate BIS Range and Propofol Effect-site Concentration During Total Intravenous Anesthesia With Concomitant Adjuvants.

The goal of this clinical trial is to determine the appropriate Bispectral Index (BIS) range and propofol effect-site concentration required to maintain adequate anesthesia depth during total intravenous anesthesia (TIVA) combined with midazolam, dexmedetomidine, or esketamine in patients undergoing unilateral knee replacement surgery. The main questions it aims to answer are: 1. What are the appropriate BIS range and propofol effect-site concentration for maintaining adequate anesthesia depth when combined with each of the three medications (midazolam, dexmedetomidine, or esketamine) during TIVA? 2. How these combination regimens affect the quality of recovery and postoperative pain in patients？ Participants will: 1. Receive one of four anesthesia regimens during surgery: propofol alone, propofol combined with midazolam, dexmedetomidine, or esketamine. 2. Undergo a stepwise reduction of propofol effect-site concentration towards the end of surgery. 3. Have their consciousness assessed using the isolated forearm technique, while BIS, EEG signals, and vital signs are continuously monitored throughout the procedure. 4. Have their recovery quality and postoperative pain assessed after surgery.

Unicompartmental Versus Total Knee Replacement for Medial Compartment Knee Osteoarthritis

For patients with osteoarthritis affecting only the inner part of the knee, surgeons can offer either a partial knee replacement, which resurfaces the worn compartment alone, or a total knee replacement. Both are recommended treatments, but there is no agreement on when to choose one over the other. Partial knee replacement preserves the anterior cruciate ligament and more of the natural knee, and recovery is usually quicker, but it is used in only about one in ten knee replacements in the United Kingdom. Studies comparing the two have mostly relied on patient questionnaires, which may not be sensitive enough to detect differences in how the knee actually functions. Studies that have measured movement directly have concentrated on level walking, which is not demanding enough to separate the two operations. Difficulty with stairs is one of the longest lasting problems patients report after knee replacement. The FLEX-UNI trial will compare the two operations using three-dimensional motion analysis during more demanding everyday activities. Forty patients who are suitable for a partial knee replacement will be randomly allocated to receive either a partial or a total knee replacement. Patients and the researchers measuring their movement will not know which operation was performed. The main measurement is how far the operated knee bends while stepping down from a 20 cm step, measured one year after surgery. Movement during walking, stair climbing, slopes, sitting and standing, and balance will also be measured, along with questionnaires, x-rays, and complications. Results will be compared against measurements from people with healthy knees.