Anesthesiology
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Randomized Controlled Trial Clinical Trial
Effect of dobutamine on splanchnic carbohydrate metabolism and amino acid balance after cardiac surgery.
As a predominant beta-adrenergic agonist, dobutamine may modify blood flow distribution and increase metabolic demands. The authors investigated the effect of a dobutamine-induced increase in cardiac output on splanchnic and femoral blood flow and metabolism in patients after cardiac surgery. ⋯ After coronary artery bypass surgery, dobutamine increased systemic and regional blood flow and decreased systemic and regional oxygen extraction. Dobutamine did not affect splanchnic glucose production or lactate or amino acid balance. This suggests that dobutamine increases splanchnic blood flow without a concomitant increase in hepatosplanchnic metabolism.
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Randomized Controlled Trial Clinical Trial
Pharyngeal mucosal pressure and perfusion: a fiberoptic evaluation of the posterior pharynx in anesthetized adult patients with a modified cuffed oropharyngeal airway.
Pharyngeal airway devices can exert substantial pressures against the pharyngeal mucosa. The authors assess the relation between pharyngeal mucosal perfusion and directly measured mucosal pressure (MP) in the posterior pharynx using a fiberoptic technique with a modified cuffed oropharyngeal airway (COPA). The authors also measure in vivo intracuff pressure (CP), airway sealing pressure and MP at four locations using an unmodified COPA. ⋯ Pharyngeal mucosal perfusion is reduced progressively in the posterior pharynx when MP is increased from 34 to 80 cm H2O with the COPA. CP provides reliable information about MP and should be less than 120 cm H2O to prevent mucosal ischemia.
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Failed or difficult tracheal intubation is an important cause of morbidity and mortality during anesthesia. Although a number of fiberoptic devices are available to circumvent this problem, many do not allow manual control of the flexion of the tip and necessitate time-consuming preparation, special training, or the use of an external light source. To improve these limitations, the authors designed a new fiberoptic stylet scope (FSS) that has a simple form of a standard stylet with the fiberoptic view and maneuverability of its tip. This study was undertaken to prospectively evaluate the effectiveness of the FSS in tracheal intubation. ⋯ Tracheal intubation using the FSS proved to be a simple and effective technique for airway management.
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The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU). ⋯ Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.
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Isovolemic anemia results in improved gas exchange in rabbits with normal lungs but in relatively poorer gas exchange in rabbits with whole-lung atelectasis. In the current study, the authors characterized the effects of hemodilution on gas exchange in a distinct model of diffuse lung injury: venous gas embolization. ⋯ Isovolemic hemodilution results in improved oxygen exchange in rabbits with lung injury induced by gas embolization. The mechanism for this improvement is not clear.