European journal of anaesthesiology
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Patients who require multidisciplinary intensive care after cardiac surgery have a poor prognosis. The aim was to investigate factors in the mortality of this group of patients at 6 months. ⋯ The 6-month mortality rate of 51% in a group of patients requiring multidisciplinary intensive care after cardiac surgery is consistent with previous studies; mortality was particularly high in extreme old age and in patients referred with sepsis or ventricular failure. Those patients with uncomplicated respiratory or renal failure had a better outcome than the group as a whole.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of clevidipine with sodium nitroprusside in the control of blood pressure after coronary artery surgery.
We set out to compare the efficacy of clevidipine and sodium nitroprusside infusions in the control of blood pressure and the haemodynamic changes they produce in hypertensive patients after operation for elective coronary bypass grafting. ⋯ There was no significant difference between clevidipine and sodium nitroprusside in their efficacy in controlling MAP. The haemodynamic changes, including tachycardia, were less pronounced with clevidipine than with sodium nitroprusside.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sedation for neuroradiology revisited: comparison of three techniques for cerebral angiography.
Previous work in our department, prior to the advent of digital subtraction angiography, showed that anaesthetist-administered sedation for cerebral angiography using propofol infusion-bolus fentanyl resulted in significantly more patients with early recall than a bolus fentanyl and midazolam technique. Our present study reassessed, 10 yr after our original study, the effectiveness of sedation for neuroradiological digital subtraction cerebral angiography, using three techniques currently in use in the department. ⋯ Our results show that since the introduction of digital subtraction angiography we may have a different end-point of sedation compared to our original study, as well as a shorter angiogram time. Satisfactory anaesthetist-administered sedation can be provided for cerebral angiography by either infusion or incremental techniques. We feel that the success and safety of a sedation technique depends considerably on the skill and experience of the administrator such that these sedation techniques are only suitable for safe use by an anaesthetist.
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Review Historical Article
A history of neuraxial administration of local analgesics and opioids.
The history of intrathecal and epidural anaesthesia is in parallel with the development of general anaesthesia. As ether anaesthesia (1846) is considered the first modern anaesthetic since its use by Morton 157 yr ago, so Bier made history by using cocaine for intrathecal anaesthesia in 1898. The first published report on opioids for intrathecal anaesthesia belongs to a Romanian surgeon, Racoviceanu-Pitesti, who presented his experience at Paris in 1901. ⋯ Over the last 30 yr, the use of epidural opioids has became a standard for analgesia in labour and delivery, and for the management of chronic pain. Finally, epidural opioids have been shown to have a pre-emptive effect, when used before major surgery. We present the evolution of neuraxial anaesthesia and the history of intrathecal and epidural administration of opioids.
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Randomized Controlled Trial Clinical Trial
Prospective, randomized, controlled evaluation of the preventive effects of positive end-expiratory pressure on patient oxygenation during one-lung ventilation.
This prospective, randomized, controlled study evaluated the effects on oxygenation by applying a selective and patient-specific value of positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation. ⋯ The selective application of PEEP to the dependent, non-operated lung increases the lung-chest wall compliance during one-lung ventilation, but does not improve patient oxygenation.