Anaesthesia
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The outcome of patients admitted to intensive care after a cardiac arrest was determined by reviewing intensive care unit records at four hospitals for 1993 and 1994. Of the 112 patients identified, 49 survived intensive care of whom 28 were discharged from hospital. In January 1996, 26 of the 28 patients could be traced; 22 of these were still alive. ⋯ In intensive care the factors were the presence of reactive pupils (p < 0.01), Glasgow Coma Score (p < 0.001), APACHE II score (p < 0.05), arterial standard bicarbonate (p < 0.05) and the use of inotropes (p < 0.05). It was not possible to use individual variables to predict outcome at the time of intensive care unit admission. The results suggest that neurological function is an important determinant of outcome and more sensitive neurophysiological testing might be a useful prognostic tool.
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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.