European journal of anaesthesiology
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The present prospective study was aimed at assessing the reliability of the pulse contour method for measuring cardiac output (CO) after different routinely used therapeutic interventions that can influence vascular compliance and systemic vascular resistances in ICU patients (fluid challenges, changes in norepinephrine or dobutamine infusion rates and changes in ventilatory settings). ⋯ In ICU patients requiring therapeutic interventions, COPC is frequently in disagreement with COTD.
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Randomized Controlled Trial
Effects of hydroxyzine-midazolam premedication on sevoflurane-induced paediatric emergence agitation: a prospective randomised clinical trial.
Anaesthesia with sevoflurane leads to a high prevalence of emergence agitation in paediatric patients. This study investigates the effects of combining hydroxyzine and midazolam on sevoflurane-induced emergence agitation in paediatric patients undergoing infraumbilical surgery with a caudal block. ⋯ The incidence of sevoflurane-induced emergence agitation was significantly lower in children premedicated with a midazolam and hydroxyzine combination compared to those premedicated with midazolam only. Furthermore, the midazolam and hydroxyzine combination provided better premedication quality than midazolam alone.
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Although volatile anaesthetics show strong and easily reproducible cardioprotective effects in animal experiments, these effects are less obvious in clinical settings. Indeed, more than a decade after the first human clinical study, the number of publications has increased extensively, but the encouraging results from previous studies in terms of myocardial protection have failed to translate into an improvement in survival or a decrease the incidence of myocardial infarction. No consensus on the modalities of administration of volatile anaesthetics has been agreed and when the experimental protocols are transposed into daily clinical practice, their cardioprotective effects are still weak. ⋯ Recent data showing anti-inflammatory properties of propofol will also be explained. One of the most important clinical benefits of propofol is that it can be used by target-controlled or continuous infusion for anaesthesia and sedation throughout the surgical and critical care periods without the risk of a transition failure. Further large multi-centre clinical investigations are still required.
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Nitric oxide acts as an important neurotransmitter as well as a sepsis mediator. During sepsis, high levels of nitric oxide, produced by the inducible form of the nitric oxide synthase (iNOS), may lead to disturbances concerning these conflicting roles and cause septic encephalopathy. To evaluate this theory, we aimed at first, to demonstrate cognitive dysfunction in a rat model based on systemic iNOS induction; second, to elucidate molecular mechanisms; and third, to prevent cognitive deficits in our sepsis model. ⋯ We demonstrate early, reversible cognitive deficits in a rat model of systemic inflammation with increased systemic iNOS activity. As systemic inhibition of iNOS activity prevented rats from the deficit in short-term memory, an involvement of systemic iNOS induction in this deficit is likely. Whether the reduced nNOS-protein expression and nNOS activity are connected to systemic iNOS induction, however, remains unclear.