Anaesthesia
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This prospective observational study aimed to assess the feasibility and efficacy of bilateral continuous paravertebral blockade combined with general anaesthesia in "on-pump" cardiac surgery. One hundred and eleven elective patients had two paravertebral catheters inserted: one either side of the midline within 2.5 cm of the spinous process of the third or fourth thoracic vertebrae, through which a mixture of ropivacaine and fentanyl was infused during and after surgery. ⋯ In all patients, time to tracheal extubation, length of stay in the intensive care unit and the hospital, morbidity and mortality, and any complication attributable to the regional blockade were recorded. The technique was associated with good haemodynamic stability, good postoperative analgesia and short times to tracheal extubation, with few significant complications.
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Hypothermia has been employed as a method of neuroprotection for many decades. The evidence base for its use is limited, and the balance between benefit and risk is unclear. We felt that in light of this confusion it would be interesting to canvas the opinion of the members of The Neuroanaesthesia Society of Great Britain and Ireland. ⋯ Forty-one per cent of respondents attempt to induce hypothermia in the head-injured patient. However, for other neurosurgical procedures most felt that the disadvantages of cooling the patient outweigh the advantages. The use of hypothermia remains a contentious issue, and as yet there is no clear answer as to whether it should be employed as a method of neuroprotection.