European journal of anaesthesiology
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One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus. ⋯ Patients with a satisfactory outcome demonstrate a decrease in pain perception thresholds and plasma concentration of stable nitric oxide metabolites during the perioperative period. Patients with an unsatisfactory outcome following lumbar discectomy experience greater preoperative anxiety and greater pain during the early postoperative period. These findings justify a larger prospective observational study.
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Comparative Study
Comparison of central and mixed venous saturation during liver transplantation in cirrhotic patients: a pilot study.
Liver transplantation is associated with important haemodynamic variations requiring cardiac output and oximetric data monitoring. The mixed venous saturation (SvO2) integrates parameters combining information about oxygen consumption, cardiac output and haemoglobin concentration. Central venous saturation (ScvO2) can be directly measured from blood drawn in the superior venous system via a central venous catheter. ScvO2 has been proposed as an alternative to SvO2 for intraoperative haemodynamic monitoring. The aim of the present study was to examine the level of agreement between SvO2 and ScvO2 during the preanhepatic and the neohepatic stage of liver transplantation in cirrhotic patients. ⋯ Measurements of SvO2 and ScvO2 showed a good level of agreement during the preanhepatic stage, whereas the level of agreement was low after liver graft reperfusion. The increase of VO2 associated with the decrease of SvO2 and the stability of ScvO2 between the two periods suggest an incomplete mixing of splanchnic venous blood into the right atrium. In addition, our samples were taken from the right atrium, which is not possible using a conventional central venous catheter, as the tip must lie in the superior vena cava and not in the right atrium. ScvO2 cannot be considered equivalent to SvO2 for the haemodynamic monitoring of patients with cirrhosis undergoing liver transplantation.
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Comparative Study Clinical Trial
The PediaSat continuous central SvO2 monitoring system does not reliably indicate state or course of central venous oxygenation.
The present study compares the accuracy of a new continuous venous oxygenation monitoring system (PediaSat Oximetry Catheter) with laboratory blood oximetry in paediatric surgical patients. ⋯ In paediatric and adolescent patients undergoing major surgery, the PediaSat system did not reliably reflect SCO-OXcvO2 values and cannot replace repeated invasive ScvO2 assessments in the clinically relevant range of ScvO2.
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Comparative Study
Incidence and impact of distracting events during induction of general anaesthesia for urgent surgical cases.
Distractions and interruptions during clinical activities can decrease performance and increase the risk of error. The incidence and impact of distracting events on anaesthetic teams during the critical phases of general anaesthesia are unknown. The purpose of this study was to quantify and analyse the frequency, the source and the impact of these events during the period of induction of general anaesthesia. ⋯ During the induction phase of general anaesthesia, distracting events are frequent and affect significantly the task at hand. Future research should design and implement preventive strategies to minimize the occurrence of unnecessary distracting events during this critical phase of anaesthesia when calm and vigilance should prevail.