European journal of anaesthesiology
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Controlled Clinical Trial
Diastolic function: the influence of pneumoperitoneum and Trendelenburg positioning during laparoscopic hysterectomy.
Several reports concerning the haemodynamic changes during gynaecologic laparoscopy have been published so far, and the effects of head-down tilt and pneumoperitoneum have not been clearly separated. However, its main effect seems to be an increase in systemic vascular resistance. We investigated how the augmented afterload can affect diastolic function. ⋯ We have found that pneumoperitoneum has important effects on left ventricular volumes, causing a drop in left ventricular end-diastolic volume; it also affects diastolic function with a delay in deceleration time and isovolumetric relaxation time without any effects on intracavitary pressures.
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Percutaneous dilational tracheostomy (PDT) is an accepted method in intensive care patients. In our neurosurgical ICU, we routinely perform PDT. We have performed 130 PDT procedures and have often observed previously reported difficulties/complications: dislocation of the endotracheal tube (ETT); frequent puncture of the ETT cuff; difficult visualization of the entire procedure because the ETT is often in the way; and risk of damaging the posterior tracheal wall due to needle puncture or rotating dilator. We believe that the rate of complications is directly related to the ability and experience of the anaesthetist carrying out the PDT. Because our hospital is a university teaching centre, PDT is often carried out by residents who are not experienced with the technique. In order to guarantee the patient's safety and to optimize the learning curve, we propose, in such circumstances, the use of a modified standard ETT. ⋯ The dedicated ETT eliminates puncturing of the ETT, rupture of the cuff and difficult direct vision. We report an optimal stability of the tube during the whole procedure and improvement in the efficacy and safety of the procedure. When residents attempt PDF for the first time, we believe that it would be safer and more practical to perform such a technique with the dedicated ETT.
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Mathematical coupling may explain in part why cardiac filling volumes obtained by transpulmonary thermodilution may better predict and monitor responses of cardiac output to fluid loading than pressures obtained by pulmonary artery catheters (PACs). ⋯ After coronary surgery, fluid responses can be similarly assessed by intermittent transpulmonary and continuous pulmonary thermodilution methods, in spite of overestimation of CCIp by CItp. Filling pressures are poor monitors of fluid responses and superiority of GEDVI can be caused, at least in part, by mathematical coupling when cardiac volume and output are derived from the same thermodilution curve.
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We sought to test whether a transient myocardial ischaemia can induce impairment of hippocampal long-term potentiation (LTP) and whether sevoflurane preconditioning can provide robust protective effects on this neurological impairment. ⋯ Sevoflurane preconditioning induced neuroprotection against impairment of hippocampal LTP resulting from myocardial ischaemia and reperfusion.
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Letter Case Reports
Cranial nerve injuries from a laryngeal mask airway.