European journal of anaesthesiology
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Observational Study
Early matrix metalloproteinase-9 concentration in the first 48 h after aneurysmal subarachnoid haemorrhage predicts delayed cerebral ischaemia: An observational study.
Delayed cerebral ischaemia from vasospasm is an important cause of complications and death after aneurysmal subarachnoid haemorrhage. There is currently no established biomarker for identifying patients at high risk of delayed cerebral ischaemia. ⋯ MMP-9 concentrations in both plasma and CSF, measured within 48 h after subarachnoid haemorrhage, were highly predictive of the occurrence of delayed cerebral ischaemia within the first 2 weeks.
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Predicting whether a fluid challenge will elicit 'fluid responsiveness' in stroke volume (SV) and arterial pressure is crucial for managing hypovolaemia and hypotension. Pulse pressure variation (PPV), SV variation (SVV) and the plethysmographic variability index (PVI) have been shown to predict SV fluid responsiveness, and the PPV/SVV ratio has been shown to predict arterial pressure fluid responsiveness under various conditions. However, these variables have not been investigated in liver cirrhosis patients. ⋯ Dynamic preload variables predicted SV fluid responsiveness. Therefore, these variables can be used for fluid management in liver cirrhosis patients receiving mechanical ventilation. In contrast, vascular tone variables did not predict arterial pressure fluid responsiveness in liver cirrhosis patients.
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Observational Study
S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery.
Postoperative cognitive dysfunction (POCD) may be related to the systemic inflammatory response and an increase in serum markers of brain injury such as S100B protein and neuron-specific enolase (NSE). ⋯ Although serum levels of S100B protein and NSE are both significantly increased postoperatively, our findings indicate that serum levels of S100B protein may be more accurate than NSE in the detection of POCD after CABG.
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Propofol, midazolam and ketamine are widely used in today's anaesthesia practice. Both neuroprotective and neurotoxic effects have been attributed to all three agents. ⋯ Propofol, but neither midazolam nor ketamine, provides neuroprotection to injured neuronal cells via inhibition of TLR-4-NF-κB-dependent signalling.