European journal of anaesthesiology
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The profession of anaesthesiologist is demanding and potentially hazardous. Extended work shifts combined with intensive work load may adversely affect physicians' performance. The aim of this study was to explore the impact of a single in-hospital 24 h shift on the cognitive and psychomotor performance of anaesthesiologists in a surgical emergency department. ⋯ Anaesthesiologists' 24 h working day in the emergency department altered cognitive and psychomotor function in comparison with ordinary working days. Speed, reliability and mental endurance (measured by TTST) were significantly impaired in all four tests. Stability and reaction time (measured by total variability) were only slightly impaired. Paradoxically, attention and alertness (measured by total number of errors) were not adversely affected. In conclusion, anaesthesiologists' psychomotor performance was impaired during the single 24 h shift.
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We studied whether changes in less invasive, noncalibrated pulse-contour cardiac output (by modified ModelFlow, COmf) and derived stroke volume variations (SVV), as well as systolic and pulse pressure variations, predict changes in bolus thermodilution cardiac output (COtd), evoked by continuous and cyclic increases in intrathoracic pressure by increases in positive end-expiratory pressure (PEEP) and tidal volume (Vt), respectively. ⋯ A fall in COmf is more sensitive than a rise in SVV, which is more sensitive than systolic pressure variation and pulse pressure variation, in tracking a fall in COtd during continuous (and not cyclic) increases in intrathoracic pressure, in mechanically ventilated patients after cardiac surgery. This suggests a reduction in biventricular preload as the main factor in decreasing cardiac output and increasing SVV with PEEP.
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Gabapentin, an anticonvulsant with analgesic effect, has been reported to be an activator of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. In this study, we tested the effect of intrathecal ZD7288, an HCN channel inhibitor, and its interaction with intrathecal gabapentin in the rat formalin test. ⋯ Our data suggest that activation of spinal or dorsal root ganglion HCN channels or both is not involved in formalin-induced pain, and intrathecal gabapentin does not act as an HCN channel activator to achieve its antinociceptive effect in the formalin test.