European journal of anaesthesiology
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Coma is a state of profound unresponsiveness that can occur as a serious perioperative complication. The study of risk factors for, and sequelae of, postoperative coma has been limited due to the rarity of the event. ⋯ This is the largest study of postoperative coma ever reported and will be useful for determining risk of coma of more than 24 h duration when evaluating an unresponsive patient following surgery. Data on prognosis will aid medical and ethical decision-making for the comatose surgical patient.
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Acute respiratory distress syndrome is characterised by activation of the inflammatory cascade. The only treatment that reduces the mortality rate associated with this syndrome is lung protective ventilation, which requires sedation of patients. Sedation in critical care units is usually induced intravenously, although there is reason to believe that inhaled anaesthetics are a suitable alternative. Sevoflurane has recently been shown to modulate the lung inflammatory response in a model of lung injury more favourably than propofol. ⋯ At 240 min, median and interquartile range (IQR) concentrations of cytokines in bronchial lavage specimens in group S were lower than those in group P [interleukin-1β (IL-1β) 53, IQR 16-140 vs. 311, IQR 183-637 pg ml, P = 0.04; tumour necrosis factor-α 347, IQR 161-433 vs. 552, IQR 475-649 pg ml, P = 0.04; and IL-6 101, IQR 76-282 vs. 580, IQR 369-701 pg ml, P = 0.03]. The polymorphonuclear neutrophil count was also lower in group S (P = 0.007), which also had a higher PaO2/FiO2 ratio.
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Cardiopulmonary bypass (CPB) is a commonly used technique in cardiac surgery but is associated with acute, transient, renal dysfunction that has a negative impact on long-term survival. ⋯ CPB induces an acute and local inflammatory response in the kidney, which might contribute to renal injury. The signalling pathways involved identified by gene expression analysis may represent pharmacological targets to limit renal injury following CPB.
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Balanced hydroxyethyl starch (HES) solutions with a molecular weight of 130 kDa (tetrastarches) are frequently used in clinical practice. These solutions are derived either from waxy maize or potato starch and they are not bioequivalent. ⋯ Bolus infusion of balanced 6% wt/vol tetrastarches augments mucosal capillary perfusion. Pulmonary inflammation in sepsis is differentially influenced by tetrastarches produced from different raw materials.