Anaesthesia
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We evaluated a new, ultra-fast response continuous cardiac output monitor in 34 adult patients undergoing off-pump coronary artery bypass graft surgery. Cardiac output was measured with the TruCCOMS continuous cardiac output monitor (Aortech International plc, Lanarkshire, UK), using triplicate cold bolus thermodilution as the criterion standard, at fixed time points during surgery and during dobutamine infusion. ⋯ The study device failed to detect the change in cardiac output caused by dobutamine accurately (y = 0.18x + 0.45; r(2) = 0.13), with an error linearly related to the magnitude of the change measured. We conclude that the device's failure to detect changes in cardiac output could be a major limitation in its clinical use in its current form.
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We have previously demonstrated that the peri-operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase-MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients undergoing major vascular surgery or major joint arthroplasty to 1 year using a patient questionnaire, general practitioner follow-up and case-notes review. Increased postoperative marker concentrations were defined as values greater than the upper reference limit. ⋯ Thirty-nine major adverse cardiac outcomes were recorded (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina, cerebrovascular accident and major arrhythmias needing active treatment). There was no association between increases in any of these cardiac markers and cardiac death to 1 year. However, increases in troponin I and both a single elevated creatine kinase-MB and two successively elevated creatine kinase-MB concentrations were associated with an increased incidence of major cardiac outcomes, including cardiac death, to 1 year (odds ratio [95% confidence intervals] = 4.19 [1.16-14.87], 3.97 [1.65-9.44] and 5.19 [1.60-16.22], respectively).
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Robert Mortimer Glover (1815-1859) was a contemporary of John Snow and James Young Simpson. Although he did not reach the standing of those two giants, his researches, writings and lectures were important contributions to the early development of British anaesthesia. Glover was the first to explore the physiological action of chloroform in the laboratory and to discover its anaesthetic effect in 1842. ⋯ His brilliant career deteriorated after his arrival in London and, especially, after his return from the Crimea, although he continued to publish until the week before his death. The causes of his decline remain obscure. The last year of his life was ruined by his addiction to chloroform, to whose development he had contributed so much, and which killed him at the early age of 43.
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Editorial Comparative Study
Nitrous oxide or remifentanil for the "at risk" brain.