European journal of anaesthesiology
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Clinical Trial
Changes in jugular bulb oxygenation in patients undergoing warm coronary artery bypass surgery (34-37 degrees C).
Imbalance between cerebral oxygen supply and demand is thought to play an important role in the development of cerebral injury during cardiac surgery with cardiopulmonary bypass. ⋯ We found that jugular bulb oxygen saturation, jugular bulb oxygen tension and oxygen extraction ratio are mainly dependent on arterial carbon dioxide tension, and arterial-jugular bulb oxygen content difference is dependent on arterial carbon dioxide tension and the bypass temperature. Our results suggest jugular bulb oxygenation is mainly dependent on arterial carbon dioxide tension during warm cardiopulmonary bypass.
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Randomized Controlled Trial Comparative Study Clinical Trial
Minimal flow sevoflurane and isoflurane anaesthesia and impact on renal function.
Compound A generation and accumulation in sevoflurane anaesthesia is dependent on fresh gas flow. We investigated the extent of generation of compound A. ⋯ Compound A concentrations using 0.5 L min-1 fresh gas flow and a heated absorber were higher than previously published values using an inflow of 1 L min-1. Compound A exposure was similar to other clinical studies which did not show changes in renal and hepatic function.
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Randomized Controlled Trial Clinical Trial
Gum elastic bougie, capnography and apnoeic oxygenation.
This study assessed the accuracy of using capnography with a modified, hollow gum elastic bougie in predicting tracheal intubation, and its effectiveness as a method of apnoeic oxygenation. ⋯ The modification of the gum elastic bougie allows a more objective assessment of correct placement than the previous tactile method. The current design of bougie is unsuitable but can be modified.
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Appropriate airway management is an essential part of the anaesthetist's role. Difficult intubation, which can now be quantified using the 'Intubation Difficulty Scale', should be anticipated whenever possible. A strategy needs to be developed in order to anticipate problems. ⋯ Three situations are considered: (a) anticipated difficult intubation, for which awake fibreoptic intubation would appear to be the technique of choice in the majority of cases, (b) unforeseen difficult intubation in a patient whose lungs can be ventilated; here, various techniques for control of the airway will be briefly described, and (c) both tracheal intubation and lung ventilation are impossible; this is a life-threatening emergency, for which three solutions are proposed. These include use of the laryngeal mask airway, the Combitube, or transtracheal ventilation. These situations will be analysed with the aim of proposing management strategies that always guarantee the safety of the patient.
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Infusion of ketamine and midazolam can maintain prolonged anaesthesia, but delayed recovery is a limitation. We aimed to develop an approximation regimen for the infusion of ketamine and midazolam to obtain steady-state anaesthesia with acceptable recovery. ⋯ It is concluded that infusion of ketamine and midazolam in the approximation regimen doses can be used to maintain anaesthesia for prolonged abdominal surgery.