European journal of anaesthesiology
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Multicenter Study Comparative Study
Fibrinolysis or hypercoagulation during radical prostatectomy? An evaluation of thrombelastographic parameters and standard laboratory tests.
Radical prostatectomy is at high risk for intraoperative and postoperative bleeding due to surgical trauma, release of urokinase and tissue type plasminogen activator. We conducted this prospective, observational multi-centre study to assess the degree of systemic fibrinolysis or hypercoagulation in the perioperative period. We studied serial changes in standard laboratory values and in thrombelastographic (TEG; Haemoscope Corporation, Skokie, IL, USA) parameters including lysis at 30 and 60 min (LY-30, LY-60), alpha-angle (alpha) and maximum amplitude. ⋯ Neither standard coagulation parameters nor TEG values showed any significant activation of fibrinolysis or of hypercoagulation in the preoperative period. Nevertheless, hypercoagulation seems to have a substantial clinical impact as it has been shown that cardiovascular complications and pulmonary embolism were the most common causes of death after retropubic prostatectomy.
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Comparative Study
The early phase of critical illness is a progressive acidic state due to unmeasured anions.
Stewart's and Fencl's methods have recently been proposed to interpret acid-base disorders where traditional theory has proven inadequate. Our objectives were to evaluate: (1) the occurrence of acid-base disturbances in critically ill patients and their trend over the first 3 intensive care unit days, (2) whether Stewart's theory offers advantages over the traditional theory in the diagnosis of acid-base metabolic disturbances and (3) whether variables derived from Stewart's and Fencl's methods offer advantages over the traditional method to predict patient mortality. ⋯ Metabolic acidosis by unmeasured anions is a clinically relevant phenomenon, which is correlated with mortality. Progressive metabolic acidosis may be ongoing in the early phase of critical illness despite the absence of acidaemia.
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Practice Guideline
Education and training in anaesthesia--revised guidelines by the European Board of Anaesthesiology, Reanimation and Intensive Care.
The expansion of the European Union during the last 2 yr has resulted in the need for a revision of existing guidelines to further harmonize education and training in the specialty of anaesthesiology throughout the European Union. Although each individual country is responsible for its own training and certification, these guidelines are intended to reflect minimum criteria for specialist training. It is the opinion of the Section and Board of Anaesthesia that specialist training will need to be for a minimum of 5 yr.
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Comparative Study
Evaluation of new laryngoscope blade for tracheal intubation, Truview EVO2: a manikin study.
Difficult airways present a clinical challenge for anaesthetists. The Truphatek Truview EVO2 (Truphatek International Ltd, Netanya, Israel) is a new laryngoscope blade used for endotracheal intubation that could be used where there is difficulty in visualizing the laryngeal inlet. ⋯ Compared with the classical Macintosh blade, the Truview EVO2 blade allowed a better view of the larynx, but did not facilitate endotracheal intubation in any of the difficult scenarios created with the adjustable manikin and in most scenarios in fact prolonged the intubation time.