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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Randomized Controlled Trial
Evaluation of antihyperalgesic and analgesic effects of 35% nitrous oxide when combined with remifentanil: A randomised phase 1 trial in volunteers.
Remifentanil is an effective drug in peri-operative pain therapy, but it can also induce and aggravate hyperalgesia. Supplemental administration of N2O may help to reduce remifentanil-induced hyperalgesia. ⋯ Administration of 35% N2O significantly reduced hyperalgesia, allodynia and pain intensity induced after remifentanil. It might therefore be suitable in peri-operative pain relief characterised by hyperalgesia and allodynia, such as postoperative pain, and may help to reduce opioid demand.
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Randomized Controlled Trial
Neuroprotective effects of intraoperative dexmedetomidine infusion combined with goal-directed haemodynamic therapy for patients undergoing cranial surgery A randomised controlled trial.
By inhibiting neuroinflammation dexmedetomidine may be neuroprotective in patients undergoing cranial surgery, but it reduces cardiac output and cerebral blood flow. ⋯ Dexmedetomidine infusion combined with GDHT may mitigate neuroinflammation without undesirable haemodynamic effects during cranial surgery and therefore be neuroprotective.
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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.