European journal of anaesthesiology
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Complex epidural simulators are now available, but these are expensive and not widely available. Simple simulators using fruit have been described before. ⋯ The banana is a cheap and easily available training tool to introduce novice anaesthetists to the feel of loss of resistance, which is best experienced before the first insertion of an epidural in a patient.
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In thoracic and abdominal surgery, epidural analgesia provides excellent pain relief, but associated postural hypotension can delay mobilisation. ⋯ Epidural analgesia is associated with arterial hypotension in the postoperative period. However, haemodynamic assessment does not predict inability to walk after thoracic and abdominal surgery. Early mobilisation should be tried irrespective of BP or orthostatic changes in postoperative patients with epidural analgesia.
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Peripheral neuropathy may affect nerve conduction in patients with diabetes mellitus. ⋯ The electrical stimulation threshold for a motor response of the sciatic nerve is increased by a factor of 7.2 in patients with diabetic foot gangrene, which might hamper nerve identification.
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The scope of this review is to provide a pathophysiological summary of perioperative right ventricular function and failure. In recent decades, the importance of right ventricular function in the perioperative period has been established. However, much of our current knowledge on the management of this clinical entity is based on extrapolation of results from left ventricular research, although biventricular physiology is known to be markedly different in many aspects. ⋯ After underlining the importance of this topic, we review basic right ventricular anatomy and physiology, with an emphasis on the role of ventricular interaction. Next, potential causes of perioperative right ventricular failure are discussed. The emphasis of this review is on the perioperative anaesthetic considerations, ranging from preoperative assessment through intraoperative monitoring to specific contemporary therapeutic options of perioperative right ventricular failure.