European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Remifentanil or sufentanil for coronary surgery: comparison of postoperative respiratory impairment.
High-dose opioid anaesthesia contributes to decreasing metabolic and hormonal stress responses in patients undergoing cardiac surgery. However, the increase in context-sensitive half-life of opioids given as a high-dose regimen can affect postoperative respiratory recovery. In contrast, remifentanil can be given in high doses without prolonging context-sensitive half-life due to its rapid metabolism. Therefore, we performed a prospective, randomized trial to compare anaesthesia consisting of propofol/remifentanil or propofol/sufentanil with regard to postoperative respiratory function and outcome. ⋯ Intraoperative use of high-dose remifentanil for coronary artery bypass grafting may be associated with improved recovery of pulmonary function and shorter postoperative hospital length of stay than sufentanil.
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Randomized Controlled Trial
Isoflurane preconditioning-induced cardio-protection in patients undergoing coronary artery bypass grafting.
Ischaemic preconditioning is commonly regarded as one of the most powerful protective mechanisms against a subsequent lethal ischaemic injury during coronary artery bypass graft surgery but is not practiced routinely. Experimentally, isoflurane, a commonly used volatile anaesthetic agent, provides myocardial protection through a signal transduction cascade that is remarkably similar to the pathways identified in ischaemic preconditioning. The aim of our study was to investigate whether pre-ischaemic administration of isoflurane exerted protection against prolonged ischaemia with functional recovery and reduced necrosis among patients undergoing coronary artery bypass graft surgery. ⋯ The present results support the preconditioning effect of isoflurane in patients undergoing coronary artery bypass graft surgery as clinically feasible and providing optimal cardiac protection.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of three facemasks used during the induction of general anaesthesia.
A prospective crossover randomized trial was conducted to compare the performance of three commonly used anaesthetic facemasks: a clear plastic 'Anaesthetic Facemask' with pre-inflated air cushion, no inflation valve, and for single use (Intersurgical Limited, Wokingham, UK), a clear plastic 'Air Cushion Mask' with inflatable air cushion and inflation valve, and for single use (Proact Medical Limited, Kettering, UK), and a black antistatic reusable rubber facemask with pre-inflated air cushion, and no inflation valve (Datex Ohmeda Limited, Hatfield, UK). ⋯ This study has shown that the antistatic rubber facemask outperformed the two plastic facemasks during routine induction of general anaesthesia. We hope this will encourage manufacturers to improve disposable facemask design to simulate the antistatic rubber facemask.
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Comparative Study Clinical Trial
Cardiac output measurements in off-pump coronary surgery: comparison between NICO and the Swan-Ganz catheter.
The aim of this prospective study was to compare continuous cardiac output measurements of the non-invasive cardiac output system (NICO) with the pulmonary artery catheter during off-pump coronary bypass surgery. ⋯ During off-pump cardiac surgery, the non-invasive cardiac output reliably measures cardiac output and does it more rapidly than a pulmonary artery catheter and may be more useful in order to detect rapid haemodynamic changes.
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Anaesthesia information management systems, though still not used widely, will inevitably replace handwritten records and may eventually serve as a core for the development of computerized decision support. We investigated staff expectations and the accuracy of data entry in a recently implemented commercially available anaesthesia information management system. ⋯ A commercially available anaesthesia information management system can be easily implemented and used instead of paper charts.