European journal of anaesthesiology
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Randomized Controlled Trial
A preemptive alveolar recruitment strategy before one-lung ventilation improves arterial oxygenation in patients undergoing thoracic surgery: a prospective randomised study.
Arterial hypoxaemia remains a problem during one-lung ventilation (OLV). We determined whether a preemptive alveolar recruitment strategy (ARS) before OLV improves arterial oxygenation during OLV in patients undergoing thoracic surgery. ⋯ Preemptive ARS before OLV is effective in improving arterial oxygenation during the entire period of OLV.
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Randomized Controlled Trial
Role of thoracic epidural block in improving post-operative outcome for septic patients: a preliminary report.
Sepsis is considered a relative contraindication for epidural blockade. Recent evidence indicates that thoracic epidural blockade may be of benefit during sepsis by improving gut perfusion. This study was planned to evaluate whether combining thoracic epidural blockade with general anaesthesia could decrease the post-operative mortality and morbidity in patients with sepsis due to perforation peritonitis. ⋯ Use of intra-operative segmental thoracic epidural blockade performed in addition to general anaesthesia suggested some benefit in improving post-operative mortality or major morbidity, but the trend was not significant, perhaps due to the small sample size. There was, however, a significantly earlier return of bowel motility and earlier discharge from hospital.
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To determine the visibility of pleural lung sliding in alveolar-interstitial syndrome (AIS) in patients on mechanical ventilation at two different time points, as a confirmatory ultrasonographic method for excluding pneumothorax. ⋯ Lung sliding specificity in AIS during mechanical ventilation was 78%. Our opinion is that different levels of airway pressure between starting mechanical ventilation and weaning trials have no influence on lung sliding visibility.
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Stopping trigger agents and prompt administration of dantrolene are the cornerstones of treatment of malignant hyperthermia. However, significant time is lost in treatment of the condition because of the cumbersome preparation and administration of the commercially available dantrolene sodium for injection. A potential improvement has become available in the form of a novel nanocrystalline dantrolene sodium suspension (DSS), which is 150 times more concentrated (50 mg ml(-1)) than the standard dantrolene sodium solution (0.33 mg ml(-1)). The aims of this study were to measure the effects of DSS on clinical and laboratory variables in malignant hyperthermia normal pigs and to compare the therapeutic management and clinical effectiveness of DSS with standard dantrolene sodium in a fulminant malignant hyperthermia crisis in susceptible pigs. The pig model is a well accepted method of studying the malignant hyperthermia crisis and is an ideal way to evaluate the variables of interest in this study. ⋯ The therapeutic action of DSS in a malignant hyperthermia crisis in pigs was effective and comparable to that of standard dantrolene sodium. However, preparation and administration of DSS were significantly faster, which may offer a clinically significant advantage in the treatment of a fulminant malignant hyperthermia crisis and may result in a reduction in stress for the anaesthesia team.