European journal of anaesthesiology
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Although volatile anaesthetics show strong and easily reproducible cardioprotective effects in animal experiments, these effects are less obvious in clinical settings. Indeed, more than a decade after the first human clinical study, the number of publications has increased extensively, but the encouraging results from previous studies in terms of myocardial protection have failed to translate into an improvement in survival or a decrease the incidence of myocardial infarction. No consensus on the modalities of administration of volatile anaesthetics has been agreed and when the experimental protocols are transposed into daily clinical practice, their cardioprotective effects are still weak. ⋯ Recent data showing anti-inflammatory properties of propofol will also be explained. One of the most important clinical benefits of propofol is that it can be used by target-controlled or continuous infusion for anaesthesia and sedation throughout the surgical and critical care periods without the risk of a transition failure. Further large multi-centre clinical investigations are still required.
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Nitric oxide acts as an important neurotransmitter as well as a sepsis mediator. During sepsis, high levels of nitric oxide, produced by the inducible form of the nitric oxide synthase (iNOS), may lead to disturbances concerning these conflicting roles and cause septic encephalopathy. To evaluate this theory, we aimed at first, to demonstrate cognitive dysfunction in a rat model based on systemic iNOS induction; second, to elucidate molecular mechanisms; and third, to prevent cognitive deficits in our sepsis model. ⋯ We demonstrate early, reversible cognitive deficits in a rat model of systemic inflammation with increased systemic iNOS activity. As systemic inhibition of iNOS activity prevented rats from the deficit in short-term memory, an involvement of systemic iNOS induction in this deficit is likely. Whether the reduced nNOS-protein expression and nNOS activity are connected to systemic iNOS induction, however, remains unclear.
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Delirium presents clinically with differing subtypes ranging from hyperactive to hypoactive. The clinical presentation is not clearly linked to specific pathophysiological mechanisms. Nevertheless, there seem to be different mechanisms that lead to delirium; for example the mechanisms leading to alcohol-withdrawal delirium are different from those responsible for postoperative delirium. ⋯ Well documented predisposing factors are age, medical comorbidities, cognitive, functional, visual and hearing impairment and institutional residence. Important precipitating factors apart from surgery are admission to an ICU, anticholinergic drugs, alcohol or drug withdrawal, infections, iatrogenic complications, metabolic derangements and pain. Scores to predict the risk of delirium based on four or five risk factors have been validated in surgical patients.
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Randomized Controlled Trial
A double bending lightwand can provide more successful endotracheal intubation in patients with a short thyromental distance: a prospective randomised study.
This study assessed the efficacy of endotracheal intubation using a double bending lightwand in patients with an anticipated difficult airway because of a short thyromental distance. ⋯ We conclude that the double bending lightwand is associated with a greater success rate of intubation in patients with an anticipated difficult airway because of a short thyromental distance.