European journal of anaesthesiology
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Observational Study
Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia: A prospective cohort study.
Surgical procedures stimulate nociception and induce physiological responses according to the balance between nociception and antinociception. The severity of surgical stimuli is associated with major postoperative complications. Although an intra-operative quantitative index representing surgical invasiveness would be useful for anaesthetic management to predict and prevent major complications, no such index is available. ⋯ Mean nociceptive response index during surgery likely correlates with major complications after gastrointestinal surgery.
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Observational Study
Assessment of the left ventricular outflow tract during cardiac anaesthesia with biplane transoesophageal echocardiography: An observational study.
Assessment of left ventricular outflow tract (LVOT) area is a key component of quantification of aortic stenosis and stroke volume. Current international guidelines recommend measurement of the LVOT diameter with two-dimensional (2D) echocardiography and assume a circle. This may lead to erroneous measures of aortic valve area and adversely affect peri-operative decision making. Multiplane orthogonal (biplane) and three-dimensional (3D) echocardiography imaging may allow more accurate calculation of LVOT, aortic valve area and stroke volume. ⋯ 2D diameter measures of the LVOT assuming a circle underestimate LVOT area, underestimate aortic valve area and increase the apparent severity of aortic stenosis. This may lead to inappropriate aortic valve intervention. In a busy operating room environment, we suggest that for the calculation of stroke volume and aortic valve area, LVOT area is measured with biplane imaging.
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There is uncertainty about how much positive end-expiratory pressure (PEEP) should be used in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). ⋯ In COVID-19 ARDS, use of higher PEEP may be associated with a lower number of VFDs, and may increase the incidence of AKI and need for RRT.