Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2017
Observational StudyDoes hypothermia impair cerebrovascular autoregulation in neonates during cardiopulmonary bypass?
Autoregulation monitoring has been proposed as a means to identify optimal arterial blood pressure goals during cardiopulmonary bypass, but it has been observed that cerebral blood flow is pressure passive during hypothermic bypass. When neonates cooled during cardiopulmonary bypass are managed with vasodilators and controlled hypotension, it is not clear whether hypothermia or hypotension were the cause of impaired autoregulation. ⋯ Arterial blood pressure, temperature, and cerebral autoregulation were collinear in this cohort. The conclusion that hypothermia causes impaired autoregulation is thus confounded. The effect of temperature on autoregulation should be delineated before clinical deployment of autoregulation monitors to prevent erroneous determination of optimal arterial blood pressure. Showing the effect of temperature on autoregulation will require a normotensive hypothermic model.
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Paediatric anaesthesia · Sep 2017
Static cerebrovascular pressure autoregulation remains intact during deep hypothermia.
Clinical studies measuring cerebral blood flow in infants during deep hypothermia have demonstrated diminished cerebrovascular pressure autoregulation. The coexistence of hypotension in these cohorts confounds the conclusion that deep hypothermia impairs cerebrovascular pressure autoregulation. ⋯ Intact steady-state cerebrovascular pressure autoregulation is demonstrated in a swine model of profound hypothermia. Lower limit of autoregulation and static rate of autoregulation were similar in hypothermic and normothermic subjects.
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Paediatric anaesthesia · Sep 2017
Brain molecular changes and behavioral alterations induced by propofol anesthesia exposure in peripubertal rats.
Propofol is commonly used in modern anesthesiology. Some findings suggest that it is highly addictive. ⋯ In peripubertal rats, propofol anesthesia exposure induces transient molecular and behavioral response that share similarities with those reported previously for addictive drugs. In the absence of additional pharmacological manipulation, all detected effects receded within 48 hour after the treatment.