Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2007
The preoperative detection of risk of anaphylaxis during anaesthesia.
In 144 patients who were referred to an anaesthetic allergy clinic because of perceived risk of anaphylaxis during anaesthesia, the only 'at risk' group that could be identified was patients with a history of unexplained severe adverse reaction during previous anaesthesia. Twenty-two of 45 patients with such a history had positive skin tests to an anaesthetic drug. ⋯ On the contrary, investigation of patients without a previous adverse reaction did not appear to be of value. These findings suggest that those patients with a history of a severe undiagnosed adverse event during previous anaesthesia should be investigated with preoperative skin-testing before undergoing further elective surgery.
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Anaesth Intensive Care · Dec 2007
Comparative StudyA comparison of 4% succinylated gelatin solution versus normal saline in stable normovolaemic sheep: global haemodynamic, regional blood flow and oxygen delivery effects.
The objective of this study was to compare the effects on regional blood flow and regional oxygen delivery of 4% succinylated gelatin solution (Gelofusine, B. Braun) with those of normal saline. This was a randomised, controlled, cross-over large animal study, which took place at the animal laboratory of university physiology institute. ⋯ Normal saline and Gelofusine have transient, volume expansion-related systemic haemodynamic effects, which are greater for Gelofusine. Saline had a more pronounced early effect on mesenteric blood flow, while Gelofusine had a sustained and progressive greater effect on renal blood flow. The transient increase in urine output and creatinine clearance seen with both fluids occurred while renal oxygen delivery decreased.
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Anaesth Intensive Care · Dec 2007
Continuous veno-venous haemofiltration attenuates myocardial mitochondrial respiratory chain complexes activity in porcine septic shock.
Increasing evidence indicates that mitochondrial dysfunction plays an important role in modulating the development of septic shock. In the present study, we investigated whether continuous veno-venous haemofiltration (CVVH) with high-volume might improve myocardial mitochondrial dysfunction in a porcine model of peritonitis-induced septic shock. Sixteen male Landrace pigs weighing 31 +/- 5 kg were randomly assigned to normal control group (n = 4), peritonitis group (n = 6) and peritonitis plus CVVH group (n = 6). ⋯ Compared with the peritonitis group, cardiac output, stroke volume and mean arterial pressure were better maintained in peritonitis plus CVVH group. More importantly, high-volume CVVH improved myocardial mitochondrial complex I activity (0.22 +/- 0.03 vs. 0.15 +/- 0.04, P = 0.04). These results suggest that high-volume CVVH improves haemodynamics and heart dysfunction in septic shock and the improvement may be attributed to amelioration of myocardial mitochondrial dysfunction.