European journal of anaesthesiology
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Letter Case Reports
Rare case of eyeball rupture following oculocardiac reflex during anaesthesia.
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Comparative Study Observational Study
Identifying optimal heparin management during cardiopulmonary bypass in obese patients: A prospective observational comparative study.
The heparin regimen providing anticoagulation during cardiopulmonary bypass (CPB) is usually adapted to total body weight (TBW), but may be inaccurate in obese patients in whom TBW exceeds their ideal body weight. ⋯ The standard heparin regimen based on TBW in obese patients during CPB results in excessive plasma heparin concentrations and a significant intraoperative decrease in haemoglobin concentration. ACT monitoring was not accurate in identifying this excess dosage. An initial bolus of 340 IU kg ideal body weight would achieve a heparin concentration of 4.5 IU ml, similar to that observed in nonobese patients. Further investigations are warranted to confirm this heparin regimen.
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Review Meta Analysis
Cardiac troponins and volatile anaesthetics in coronary artery bypass graft surgery: A systematic review, meta-analysis and trial sequential analysis.
Reports from animal studies indicate that volatile anaesthetics protect the myocardium against the effects of acute ischaemia-reperfusion injury by reducing infarct size. This cardioprotective effect in the clinical setting of coronary artery bypass graft (CABG) surgery, where the heart is subjected to global ischaemia-reperfusion injury, remains controversial. ⋯ Studies investigating the cardioprotective effect of volatile anaesthetics on cardiac troponins in on-pump CABG surgery are no longer warranted. This is not yet the case for off-pump surgery.
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Randomized Controlled Trial
Anaesthetic induction with etomidate in cardiac surgery: A randomised controlled trial.
Etomidate is perceived as preserving haemodynamic stability during induction of anaesthesia. It is also associated with adrenocortical dysfunction. The risk/benefit relationship is controversial. ⋯ In elective cardiac surgery, laboratory indicators of etomidate-induced adrenal insufficiency do not translate into increased vasopressor requirement or inferior early outcomes.
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Major noncardiac surgery is associated with a 5% incidence of serious cardiovascular complications and with a 1 to 2% probability of death from cardiac causes. Over the last few decades, researchers have assessed the perioperative predictive power of several risk indices. Research is currently focused on the evaluation of biomarkers. ⋯ High levels of preoperative and postoperative NT-proBNP are predictors of cardiovascular complications, including all-cause mortality, during the first 30 days after noncardiac surgery in adults with cardiovascular risk factors.