European journal of anaesthesiology
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Randomized Controlled Trial Clinical Trial
Effects of sodium nitroprusside-induced controlled hypotension on pancreatic function assessed by pancreatitis-associated protein in patients undergoing radical prostatectomy.
Controlled hypotension may alter organ blood flow and tissue oxygenation. The aim of the study was to investigate whether induced hypotension using sodium nitroprusside alters pancreatic function assessed by pancreatitis-associated protein concentrations in the blood. ⋯ Controlled hypotension during surgery was associated with a small but significant increase in pancreatitis-associated protein compared with controls. The absence of concomitant elevation in lipase concentrations and a lack of clinical evidence of pancreatitis damage suggest that hypotension induces mild pancreatic stress.
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We investigated whether an increase in anaesthesia staffing to permit induction of anaesthesia before the previous case had ended ('overlapping') would increase overall efficiency in the operating room. Hitherto, the average duration of operating sessions was too long, thus impeding the timely commencement of physicians' ward duties. ⋯ The time between surgical operations decreased significantly. Increased operating room efficiency owing to overlapping induction of anaesthesia allows more intense scheduling of operations. Thus, physicians and nurses can be released to spend more time with their patients in the ward. Improving the efficiency of the operating room alone is insufficient to improve human resource management at all levels of a surgical clinic.
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Laudanosine is a metabolite of the neuromuscular-blocking drugs atracurium and cisatracurium with potentially toxic systemic effects. It crosses the blood-brain barrier and may cause excitement and seizure activity. Its interest in recent years has increased because of the recognized interaction with gamma-aminobutyric acid, opioid and nicotinic acetylcholine receptors. ⋯ Except for prolonged administration of atracurium in intensive care units, laudanosine accumulation and related toxicity seem unlikely to be achieved in clinical practice. When cisatracurium is used, plasma concentrations of laudanosine are lower. Further studies are needed, especially around the interactions with gamma-aminobutyric acid, opioid and nicotinic acetylcholine receptors.