European journal of anaesthesiology
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Comparative Study
Role of nuclear factor-κB in volatile anaesthetic preconditioning with sevoflurane during myocardial ischaemia/reperfusion.
Anaesthetic preconditioning (APC) protects against myocardial ischaemia/reperfusion injury. Nuclear factor-kappaB (NF-kappaB) has been implicated in APC-induced myocardial protection in vitro. Our study tested the hypothesis that in-vivo APC with sevoflurane is triggered by NF-kappaB through downregulation of inflammatory mediators and upregulation of antiapoptosis factors to prevent myocardial injury during ischaemia/reperfusion. ⋯ APC with sevoflurane produced myocardial protection against ischaemia/reperfusion in vivo. NF-kappaB acted not only as a trigger but also as a mediator that played an important role in APC through upregulation of NF-kappaB and the antiapoptosis protein Bcl-2 during the preconditioning period and then through downregulation of the inflammatory proteins intercellular adhesion molecule-1 and tumour necrosis factor-alpha during reperfusion, ultimately decreasing caspase-3 expression and apoptosis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Bispectral index-controlled postoperative sedation in cardiac surgery patients: a comparative trial between closed loop and manual administration of propofol.
Postoperative cardiac surgery patients are usually sedated according to clinical sedation scores. Electrophysiological data derived from electroencephalography, such as the bispectral index (BIS), have been reported to assess and quantify the level of sedation, although experience in these patients is limited. In the current study, we evaluated a closed-loop system - closed-loop anaesthesia delivery system (CLADS) - for postoperative sedation after open heart surgery using BIS. ⋯ Closed-loop delivery of propofol to control BIS for postoperative sedation is feasible and efficient after cardiac surgery.
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Tracheostomy is performed in about a quarter of ICU patients requiring prolonged mechanical ventilation, weaning from assisted ventilation, airway suction and airway protection. Tracheostomy improves patient comfort compared with standard intubation. Tracheostomy performed early upon ICU admission has not shown survival benefits. ⋯ It is not known which of the percutaneous techniques is safer in terms of perioperative complications. Ultrasound scanning of the neck and routine endoscopy during the procedure appear to reduce early complications. Decannulation is often delayed and an intensivist-led follow-up may facilitate timely removal of tracheostomy tubes in step down areas or wards.
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Comparative Study
Poor performances of EuroSCORE and CARE score for prediction of perioperative mortality in octogenarians undergoing aortic valve replacement for aortic stenosis.
Although results of cardiac surgery are improving, octogenarians have a higher procedure-related mortality and more complications with increased length of stay in ICU. Consequently, careful evaluation of perioperative risk seems necessary. The aims of our study were to assess and compare the performances of EuroSCORE and CARE score in the prediction of perioperative mortality among octogenarians undergoing aortic valve replacement for aortic stenosis and to compare these predictive performances with those obtained in younger patients. ⋯ Predictive performances of these scores are poor in octogenarians undergoing cardiac surgery, especially aortic valve replacement. Risk assessment and therapeutic decisions in octogenarians should not be made with these scoring systems alone.
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Airway pressure release ventilation (APRV) may provide better alveolar recruitment at a lower peak airway pressure than conventional mechanical ventilation (CMV) and, therefore, decrease the risk of barotrauma in patients with acute lung injury and acute respiratory distress syndrome. The present study compared the effects of APRV with low tidal volume ventilation (LTV) and CMV on the ongoing response in lung injury induced by whole lung lavage. ⋯ APRV reduces bronchoalveolar lavage fluid HMGB1 levels and lung water and it preserves oxygenation and systemic blood pressure in experimental acute respiratory distress syndrome. The results suggest that APRV could be as protective for acute respiratory distress syndrome as LTV with positive end-expiratory pressure.