European journal of anaesthesiology
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The objective was to carry out a retrospective study of changes in regional cerebral oxygen saturation (rSO2) using the Somanetics Invos Cerebral Oximeter (SICO) in older patients undergoing prolonged major abdominal surgery. Since evidence is accumulating that detection and correction of falls in rSO2 may be associated with a reduced incidence of postoperative cognitive dysfunction, the study assessed the incidence and possible predisposing factors for significant falls in rSO2 and strategies for correction. ⋯ This retrospective study confirms that a significant reduction in rSO2 is a common accompaniment to prolonged major abdominal surgery in elderly patients, especially if associated with blood loss, and is correctable by blood transfusion. In most cases, these changes would have gone unnoticed with conventional monitoring.
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Letter Case Reports
Drotrecogin alpha and anticoagulants in septic patients after cardiac surgery.
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Randomized Controlled Trial Comparative Study
Comparison of diphenhydramine and lidocaine for prevention of pain after injection of propofol: a double-blind, placebo-controlled, randomized study.
Pain on injection is still a problem with propofol. The purpose of the study was to compare the effectiveness of diphenhydramine and lidocaine on pain caused by propofol at the site of injection. ⋯ Previous injection of diphenhydramine with venous occlusion can be considered as an alternative to lidocaine for reducing the prevalence of pain caused by injection of propofol into peripheral veins.
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Randomized Controlled Trial
Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.
Arterial oxygenation may be compromised in morbidly obese patients undergoing bariatric surgery. The aim of this study was to evaluate the effect of a vital capacity manoeuvre (VCM), followed by ventilation with positive end-expiratory pressure (PEEP), on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery. ⋯ The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.
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A growing body of experimental evidence suggests that anaesthetics, by influencing GABAergic and glutaminergic neural signalling, can have adverse effects on the developing central nervous system. The biological foundation for this is that gamma-aminobutyric acid and glutamate could act non-synaptically, in addition to their role in neurotransmission in the adult brain, in the regulation of neuronal development in the central nervous system. These neurotransmitters and their receptors are expressed from very early stages of central nervous system development and appear to influence neural progenitor proliferation, cell migration and neuronal differentiation. ⋯ Importantly, recent data suggest that even low, non-apoptogenic concentrations of anaesthetics can perturb neuronal dendritic development and thus could potentially lead to impairment of developing neuronal networks. The extrapolation of these experimental observations to clinical practice is of course very difficult and requires extreme caution as differences in drug concentrations and exposure times as well as interspecies variations are all important confounding variables. While clinicians should clearly not withhold anaesthesia based on current animal studies, these observations should urge more laboratory and clinical research to further elucidate this issue.