European journal of anaesthesiology
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Observational Study
Validation of rotational thromboelastometry during cardiopulmonary bypass: A prospective, observational in-vivo study.
Rotational thromboelastometry (ROTEM) is a whole blood point-of-test used to assess the patient's coagulation status. Three of the available ROTEM tests are EXTEM, INTEM and HEPTEM. In the latter, heparinase added to the INTEM reagent inactivates heparin to reveal residual heparin effect. Performing ROTEM analysis during cardiopulmonary bypass (CPB) might allow the anaesthesiologist to anticipate the need for blood products. ⋯ HEPTEM and EXTEM measurements are valid in the presence of very high heparin concentrations and can be performed before protamine administration in patients undergoing cardiac surgery with CPB.
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Observational Study
Robotic assisted prostatic surgery in the Trendelenburg position does not impair cerebral oxygenation measured using two different monitors: A clinical observational study.
Robotic assisted prostatic surgery is frequently used because of its reduced side-effects compared with conventional surgery. During surgery, an extreme Trendelenburg position and CO2 pneumoperitoneum are necessary, which may lead to cerebral oedema, can potentially reduce brain perfusion and therefore could impair cerebral oxygenation. Cerebral oxygen saturation can be measured non-invasively using near-infrared spectroscopy (NIRS). ⋯ Both monitors showed a clinically irrelevant decrease in cerebral oxygen saturation of less than 5% over 4 h in a steep Trendelenburg position combined with CO2 pneumoperitoneum in patients undergoing robotic assisted prostatic surgery. This extreme positioning seems to be acceptable with regard to cerebral oxygenation.
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Observational Study
Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance.
Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being. ⋯ Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.
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Observational Study
Effect of head rotation during surgery in the prone position on regional cerebral oxygen saturation: A prospective controlled study.
Near-infrared spectroscopy (NIRS) has been used to study regional cerebral blood oxygen saturation (rScO2) in patients in the prone position. ⋯ We recommend the neutral head position for prone patients.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01760369.