European journal of anaesthesiology
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Case Reports
Treatment of a case of acute right heart failure by inhalation of iloprost, a long-acting prostacyclin analogue.
Perioperative acute right heart failure after orthotopic heart transplantation contributes significantly to morbidity and mortality. Vasodilators administered intravenously may decrease pulmonary vascular resistance, but also affect systemic circulation. A decrease of mean arterial pressure will result in reduced right coronary blood flow and deterioration of right ventricular performance. ⋯ No profound effect on the systemic vascular resistance was observed (-2.8%). Iloprost inhalation may be an effective alternative to nitric oxide in the intensive care management of acute right heart failure after orthotopic heart transplantation. Due to the prolonged effect on the pulmonary vascular resistance, iloprost is especially useful for extubated patients.
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Transoesophageal echocardiography is increasingly used for evaluation and monitoring of left ventricular function in anaesthetized patients. However, the only available reference values for transoesophageal echocardiography were derived from studies in awake subjects. ⋯ We propose using the values obtained in our study as reference values for evaluation of left ventricular function in patients under general anaesthesia and controlled ventilation.
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A postal survey was conducted in order to investigate current practice in airway management amongst Dutch anaesthetists and to investigate the role of recent training and the role of an 'Access to the Airway' airway management course. ⋯ Dutch anaesthetists, who commenced anaesthetic training after 1988, and those who attended the airway management course 'Access to the Airway' are significantly more likely to follow the American Society of Anesthesiologist's Difficult Airway Algorithm and to use adjunctive techniques for airway management.