Anaesthesia
-
Comparative Study
The value of pulse pressure and stroke volume variation as predictors of fluid responsiveness during open chest surgery.
We investigated the ability of pulse pressure variation and stroke volume variation to predict fluid responsiveness during mechanical ventilation in patients undergoing open chest surgery by comparing their respective correlations with cardiac output changes induced by leg elevation. Serial leg elevation manoeuvres were performed before and after sternotomy in 15 patients scheduled for elective off-pump coronary bypass surgery. ⋯ These correlations were lost for both parameters following sternotomy. Our data show that pulse pressure variation and stroke volume variation are valid predictors of fluid responsiveness under closed chest conditions but that this property no longer holds when the chest is open.
-
Case Reports
Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series.
General anaesthesia is the fastest method for anaesthetising a category-1 caesarean section but is associated with increased maternal morbidity and mortality. We describe the 'rapid sequence spinal' to minimise anaesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anaesthesia if there are delays or problems. ⋯ Our data indicate that one might expect to establish anaesthesia in 6-8 min using a rapid sequence spinal. Careful case selection is crucial. While rapid anaesthesia is important, the reduction of the decision-delivery interval also requires attention to other stages in the pre-operative process.
-
Case Reports
Acute hypotension associated with leucocyte depletion filters during cell salvaged blood transfusion.
Summary Intra-operative cell salvage is used in more than 75% of NHS hospitals in the United Kingdom and is a safe and cost effective alternative to allogenic blood transfusion. We report a case of acute hypotension during reinfusion of cell salvaged blood through a leucocyte depletion filter that occurred during a caesarean section. We review the literature of hypotension associated with the use of bedside leucocyte depletion filters.