European journal of anaesthesiology
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Mediastinal mass syndrome remains an anaesthetic challenge that cannot be underestimated. Depending on the localization and the size of the mediastinal tumour, the clinical presentation is variable ranging from a complete lack of symptoms to severe cardiorespiratory problems. The administration of general anaesthesia can be associated with acute intraoperative or postoperative cardiorespiratory decompensation that may result in death due to tumour-related compression syndromes. ⋯ In the case of severe clinical symptoms and large mediastinal tumours, we consider it absolutely essential to cannulate the femoral vessels preoperatively under local anaesthesia and to provide for the availability of cardiopulmonary bypass in the operating theatre, should extracorporeal circulation become necessary. The benefits of establishing vascular access under local anaesthesia clearly outweigh any associated degree of patient discomfort. In the case of patients classified as 'safe' or 'uncertain', a preoperative consensus with the surgeons should be reached as to the anaesthetic approach and the management of possible complications.
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It is not known whether anaesthetic practices for ASA I parturients undergoing scheduled caesarean delivery have changed since the last (1996) survey and how practices reflect current recommendations. ⋯ Overall practice was in accordance with national guidelines or practice patterns defined by the expert committee. Regional anaesthesia and postoperative analgesia-related techniques particularly were adequate. Some deficits were of limited importance (antibiotic prophylaxis and oxytocin administration), whereas others (use of succinylcholine and cricoid pressure) remain of concern.
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Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery. ⋯ Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.
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Ketamine, which is a general anaesthetic that induces a dissociative anaesthesia, acts by blocking the N-methyl-D-aspartate receptor (NMDAr) in the brain. Although ketamine elevates blood pressure under the clinical setting, the in-vitro effect of ketamine is vasodilatory. However, it is not clear yet whether the vasodilation by ketamine involves functions of the NMDAr. Therefore, we examined whether the NMDAr is functional in vascular smooth muscle and whether the vasodilatory effect of ketamine is associated with the NMDAr. ⋯ These results suggest that the NMDAr is not functional in vascular smooth muscle, and the vasodilatory action of ketamine is independent of the NMDAr in the rat mesenteric artery.