European journal of anaesthesiology
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The myocardial performance index is a non-geometric, heart rate-independent echocardiography-derived index of left ventricular performance combining systolic and diastolic function. There is an ongoing debate whether the myocardial performance index is affected by preload or not. Moreover, a systematic evaluation of the effect of changing tidal volume ventilation on the myocardial performance index is still lacking. The aim of our study was to assess whether acute changes in preload and/or different depth of tidal volume ventilation affect the myocardial performance index. ⋯ The myocardial performance index is largely dependent on changes in preload. Moreover, high tidal volume ventilation significantly impaired the myocardial performance index.
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Randomized Controlled Trial Comparative Study
Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study.
We compared the efficacy of intravenous lornoxicam vs. dipyrone in patient-controlled analgesia for postoperative analgesia. ⋯ Lornoxicam has better tolerability and is a more effective analgesic than dipyrone when administered by patient-controlled analgesia for postoperative analgesia after septorhinoplasty.
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Letter Case Reports
Recombinant factor VIIa in massive obstetric haemorrhage.
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During off-pump coronary bypass grafting, surgical manipulation and dislocation of the heart may cause cardiovascular instability. Monitoring of cardiac output facilitates intraoperative haemodynamic management but pulmonary artery catheters are often considered too invasive. Pulse contour analysis and transoesophageal echocardiography could serve as alternatives, but there is controversy about their accuracies. We validated pulse contour analysis using a standard radial arterial catheter (PulseCO) and aortic Doppler flowmetry with transoesophageal echocardiography in patients undergoing off-pump coronary bypass surgery. Pulmonary arterial thermodilution served as the reference technique. ⋯ Calibrated pulse contour analysis using the PulseCO system is an acceptable technique to measure cardiac output non-invasively in off-pump coronary bypass patients. Doppler echocardiography performs less well and is not always feasible with transoesophageal echocardiography when the heart is displaced.
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Levosimendan is a calcium-sensitizing drug that enhances myocardial contractility without increasing intracellular calcium. By activating adenosine triphosphate-dependent potassium channels it exerts cardioprotective and vasodilatory effects. ⋯ In this retrospective matched pair analysis of 52 patients undergoing emergency coronary artery bypass grafting for acute ischaemia, levosimendan reduced morbidity. The reduced morbidity did not translate into reductions in mortality or length of stay. A larger, prospective randomized trial is warranted to confirm the potentially beneficial effects of levosimendan in patients with acute ischaemia.