European journal of anaesthesiology
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Accumulating preclinical data indicate that neonatal exposure to general anaesthetics is detrimental to the central nervous system. Some studies, however, display potential protective effects of exactly the same anaesthetic agents on the immature brain. The effects of inhaled anaesthetics on the developing brain have received close attention from researchers, clinicians and the public in recent decades. ⋯ The majority of studies have linked inhaled anaesthetics to toxic effects in the neonatal brain of rodents, piglets and primates. Only a few studies, however, could demonstrate long-lasting cognitive impairment. The results of inhalational anaesthetic-induced neuroprotection in perinatal hypoxic-ischaemic brain injury are a promising basis for more research in this field. In general, prospective clinical trials are needed to further differentiate the effects of inhaled anaesthetics on the immature brain.
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Target-controlled infusions (TCIs) of propofol are commonly used for general anaesthesia. The Marsh model pharmacokinetic parameter set incorporated in TCI devices for propofol could increase bias when used in obese patients. ⋯ BMI influences blood propofol concentrations, leading to the possibility of overdosage of propofol in obese patients when the Marsh model is used to assess propofol concentration. Our new method using corrected Cp might improve this bias in obese, Japanese patients.
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Review Meta Analysis
The effect of perioperative administration of glucocorticoids on pulmonary complications after transthoracic oesophagectomy: A systematic review and meta-analysis.
Severe pulmonary complications occur frequently following transthoracic oesophagectomy. An exaggerated immunological response is probably a main driving factor, and this might be prevented by perioperative administration of a glucocorticoid. ⋯ In this meta-analysis, perioperative administration of glucocorticoid did not affect the risk of pulmonary complications after transthoracic oesophagectomy, nor did it cause adverse effects. A subgroup analysis showed that a weight-dependent dose of methylprednisolone 10 to 30 mg kg within 30 min preoperatively might be the most promising dosing regimen for further research.
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Randomized Controlled Trial
The effect of ketamine on hypoventilation during deep sedation with midazolam and propofol: A randomised, double-blind, placebo-controlled trial.
Hypoventilation is a major cause of morbidity and mortality in patients having procedures under sedation. Few clinical strategies have been evaluated to reduce intraoperative hypoventilation during surgical procedures under deep sedation. ⋯ Ketamine decreased the duration and severity of hypercapnia in patients undergoing deep sedation with propofol. The addition of ketamine may reduce hypoventilation and adverse effects in patients having procedures under sedation.