European journal of anaesthesiology
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Cases of ischaemic brain damage have been reported in relatively healthy patients undergoing shoulder surgery in the beach chair position. Unrecognised cerebral hypoperfusion may have contributed to these catastrophic events, indicating that routine anaesthesia monitoring may not suffice. Near-infrared spectroscopy (NIRS) provides a non-invasive, continuous method to measure regional cerebral oxygen saturation (rScO2). ⋯ The high prevalence of significant cerebral oxygen desaturation during shoulder surgery in the upright position underlines the need for close monitoring. NIRS might constitute a valuable technique to detect cerebral hypoperfusion in this high-risk group of patients.
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Comparative Study
Point-of-care prothrombin time testing in paediatric intensive care: an observational study of the ease of use of two devices.
Two major difficulties arise when taking blood samples in children: the challenge of venous access and the comparatively large amount of blood required. ⋯ CoaguChek XS Plus showed 'good' agreement, whereas CoaLine showed 'moderate' agreement compared with prothrombin time values using the standard method. The fast availability of results and the reduction of the required blood volume are advantages of point-of-care tests in the paediatric setting.
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We present a 42-year-old woman with unexpected coma after laparoscopic partial hepatectomy. MRI demonstrated ischaemic cerebral lesions. ⋯ After 5 days of intensive care, she made a near complete recovery. Perioperative stroke, paradoxical emboli during surgery, patent foramen ovale, carbon dioxide cerebral embolism and therapeutic strategies are discussed.
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The aim of this study was to assess and compare the ability of the automatically and continuously measured stroke volume variation (SVV) obtained by FloTrac/Vigileo, and pulse pressure variation (PPV) measured by an IntelliVue MP monitor, to predict fluid responsiveness in mechanically ventilated septic shock patients. ⋯ The SVV, obtained by FloTrac/Vigileo, and the automated PPV, obtained by the IntelliVue MP monitor, showed comparable performance in terms of predicting fluid responsiveness in passively ventilated septic shock patients, with a regular cardiac rhythm and a tidal volume not less than 8 ml kg(-1).