Anaesthesia
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Guidelines for cardiac anaesthesia could reduce irrational variation in practice and so improve cardiac surgical outcome. In October 1994, a postal survey was undertaken to determine the views and attitudes of consultant cardiac anaesthetists in the United Kingdom towards guidelines. ⋯ Responses to other parts of the questionnaire showed that those against guidelines for cardiac anaesthesia were less positive towards their advantages and more negative to their disadvantages compared with those in their favour. The majority of cardiac anaesthetists, although believing them to be valuable in medicine, do not want guidelines for cardiac anaesthesia because they are concerned that guidelines would be inflexible and would neither reduce variation in, nor improve the quality of, cardiac anaesthesia.
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Case Reports
Near-infrared spectroscopy changes during hypothermic circulatory arrest with retrograde cerebral perfusion.
We report on the changes in cerebral near-infrared spectroscopy during grafting of a thoraco-abdominal aneurysm. A 58-year-old man presented with a complex dissecting aortic aneurysm. Repair of the aneurysm was performed under hypothermic circulatory arrest with retrograde cerebral perfusion. ⋯ When retrograde cerebral perfusion was commenced the signals representing total haemoglobin, oxygenated haemoglobin and cytochrome aa3 were all restored to near baseline values. Deoxygenated haemoglobin, however, remained elevated. These changes support the hypothesis that some cerebral perfusion occurs during retrograde cerebral perfusion.