European journal of anaesthesiology
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Pulmonary hypertensive patients going for surgery are at significant risk of perioperative morbidity and mortality. They pose a clinically challenging situation for the anaesthetist and strategies to minimize the effects on these patients are discussed. Recent advances have allowed a better understanding of the pathophysiological mechanisms and development of new therapies. ⋯ An update on the recent advances in medical therapy with calcium channel blockers, prostacyclin analogues, endothelin receptor antagonists and phosphodiesterase-5 inhibitors is provided and relevant anaesthetic concerns highlighted. Key strategies for intraoperative management are presented and we review the options and novel strategies for managing an acute episode of decompensated pulmonary hypertension intraoperatively. Promising new therapies being explored include intraoperative delivery of inhaled milrinone and inhaled prostacyclin analogues.
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The bispectral index (BIS) is derived from the EEG and therefore may be useful to diagnose intraoperative cerebral ischaemia. This study was undertaken to investigate BIS changes in awake patients with and without neurological deficits during carotid endarterectomy under regional anaesthesia. ⋯ Our results describe a relationship between BIS reductions and neurological deficits during carotid surgery in awake patients.
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Microcirculatory alterations are thought to be responsible for much of the morbidity and mortality from sepsis. The aim of the present study was to characterize the buccal microvascular response in patients with septic shock using combined laser Doppler flowmetry/visual light spectroscopy measurements. ⋯ Buccal laser Doppler flowmetry/visual light spectroscopy may be useful for tracing microvascular alterations in critically ill patients. The surgical stress response was associated with alterations in local flow with preserved microHbO2. However, in patients with septic shock, microHbO2 was reduced in the deep channel, probably muscular tissue, with no changes in microvascular flow.
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Retraction Of Publication
Pharmacokinetics and pharmacodynamics of the new propofol prodrug GPI 15715 in rats: Retraction.