Anaesthesia
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Biography Historical Article
Nikolay Ivanovich Pirogov: a surgeon's contribution to military and civilian anaesthesia.
A key figure in the development of anaesthesia in Russia was the surgeon Nikolay Ivanovich Pirogov (1810-1881). He experimented with ether and chloroform and organised the general introduction of anaesthesia in Russia for patients undergoing surgery. He was the first to perform systematic research into anaesthesia-related morbidity and mortality. More specifically, he was one of the first to administer ether anaesthesia on the battlefield, where the principles of military medicine that he established remained virtually unchanged until the outbreak of the Second World War.
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Measurement of left ventricular stroke volume and cardiac output is very important for managing haemodynamically unstable or critically ill patients. The aims of this study were to compare stroke volume measured by three-dimensional transoesophageal echocardiography with stroke volume measured using a pulmonary artery catheter, and to examine the ability of three-dimensional transoesophageal echocardiography to track stroke volume changes induced by haemodynamic interventions. This study included 40 cardiac surgery patients. ⋯ The concordance rate in the 4-quadrant analysis after phenylephrine and ephedrine administration was 75% and 84%, respectively. In the polar-plot analysis, the angular concordance rate was 66% and 73% after phenylephrine and ephedrine administration, respectively. Three-dimensional transoesophageal echocardiography was clinically acceptable for measuring stroke volume; however, it was not sufficiently reliable for tracking stroke volume changes after haemodynamic interventions.
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Although electroencephalogram reactivity (i.e. transient changes in electrical brain activity following external stimulus) might be useful in depth-of-anaesthesia monitoring, it has not been systematically examined with different anaesthetics at doses titrated to unresponsiveness. Three 10-subject groups of healthy volunteers received dexmedetomidine, propofol or sevoflurane in escalating pseudo-steady-state concentrations at 10-min intervals until they did not open their eyes to command. The electroencephalogram was continuously recorded and spectral variables were calculated with short-time Fourier transform and time-varying autoregressive modelling. ⋯ Dexmedetomidine, propofol and sevoflurane induced distinct suppression patterns on the electroencephalogram reactivity at the same clinical endpoint (unresponsiveness). Reactivity was best maintained with propofol, while only minimally preserved with dexmedetomidine and sevoflurane. Thus, it may be difficult to harness reactivity for depth-of-anaesthesia monitoring.