European journal of anaesthesiology
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Letter Case Reports
Spinal anaesthesia and neuromyelitis optica: cause or coincidence?
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Randomized Controlled Trial Comparative Study
Comparative evaluation of propofol 350 and 200 mg for induction of anaesthesia in morbidly obese patients: a randomized double-blind pilot study.
The aim of this pilot study was to evaluate efficacy and safety of propofol 350 versus 200 mg for induction of anaesthesia in morbidly obese patients undergoing bariatric surgery. ⋯ Although propofol 200 mg proved to be an inadequate induction dose for morbidly obese patients, the 350 mg induction dose deserves further study, provided the maintenance dose is not started within 5 min, thereby preventing temporary cardiovascular instability.
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Comparative Study
Positive end-expiratory pressure improves end-expiratory lung volume but not oxygenation after induction of anaesthesia.
Induction of anaesthesia promotes collapse of dependent lung regions in both obese and nonobese patients. We hypothesized that end-expiratory lung volume (EELV) may be more sensitive than oxygenation to evaluate the effects of positive end-expiratory pressure (PEEP) after anaesthesia induction. ⋯ After induction of anaesthesia, mechanical ventilation with ZEEP is associated with a profound reduction in EELV. PEEP improves efficiently EELV and respiratory mechanics, with no major effect on oxygenation. EELV may be a useful indicator to guide PEEP setting in the operating room.
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Randomized Controlled Trial Comparative Study
Study of the systemic and pulmonary oxidative stress status during exposure to propofol and sevoflurane anaesthesia during thoracic surgery.
General anaesthesia during mechanical ventilation can induce variable systemic and pulmonary immune effects that may affect postoperative outcome. The aim of the present study was to evaluate evidence of oxidative stress in the blood and bronchoalveolar lavage (BAL) fluid of patients exposed to propofol or sevoflurane anaesthesia during thoracic surgery. ⋯ Sevoflurane seemed to induce a local and systemic oxidative stress, whereas propofol is more likely to have antioxidant properties. Sevoflurane appears to cause a greater intrapulmonary proinflammatory response than propofol during thoracic surgery.
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Accurate assessment of a patient's volume status is an important goal for an anaesthetist. However, most variables assessing fluid responsiveness are either invasive or technically challenging. This study was designed to compare the accuracy of arterial pressure-based stroke volume variation (SVV) and variations in the pulse oximeter plethysmographic waveform amplitude as evaluated with the noninvasive calculated pleth variability index (PVI) with central venous pressure to predict the response of stroke volume index (SVI) to volume replacement in patients undergoing major surgery. ⋯ Although arterial pressure-derived SVV revealed the best correlation to volume-induced changes in SVI, the results of our study suggest that both variables, SVV and PVI, can serve as valid indicators of fluid responsiveness in mechanically ventilated patients undergoing major surgery.