British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial Retracted Publication
Does the type of volume therapy influence endothelial-related coagulation in the critically ill?
The endothelium plays an important role in the regulation of haemostasis by producing substances such as thrombomodulin (TM). The influence of long-term volume replacement with different types of fluid on the TM-protein C-protein S system was investigated in a prospective, randomized study. Thirty trauma patients and 30 patients suffering from sepsis after major surgery received either 10% low-molecular weight (LMW) hydroxyethylstarch solution (HES-trauma, n = 15; HES-sepsis, n = 15) or 20% human albumin (HA-trauma, n = 15; HA-sepsis, n = 15) for 5 days to maintain central venous pressure (CVP) between 12 and 16 mm Hg. ⋯ TAT (indicating intravascular coagulation) did not differ between the two fluid groups. We conclude that in trauma patients, the type of volume therapy had no influence on the TM-protein C-protein S system. In sepsis patients, volume therapy with HES was beneficial, whereas infusion of HA had no substantial positive effect on endothelial-associated coagulation.
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Randomized Controlled Trial Clinical Trial
Effect of digital pressure on the neurovascular sheath during perivascular axillary block.
We have assessed prospectively the influence of digital pressure on the effectiveness of perivascular axillary block using a catheter technique in two groups of patients. Ninety-eight patients received axillary injections of 2% mepivacaine with adrenaline 20 ml mixed with contrast agent 20 ml. During injection firm digital pressure was applied either on the neurovascular sheath (group 1) or 6-8 cm below it (group 2). ⋯ There were no statistically significant differences in proximal flow of mepivacaine or in the success rate of the block between the groups. Signs of flow obstruction by the head of the humerus were seen in only eight patients. In the majority of patients local anaesthetic spread above the coracoid process, which increased the success rate of the block, but did not guarantee an effective block.
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Review Case Reports
Intraoperative transoesophageal echocardiography for implantation of a pulsatile left ventricular assist device.
We describe the insertion of a permanent implantable left ventricular assist device and intraoperative transoesophageal echocardiography in this instance. We also review the literature on the use of intraoperative transoesophageal echocardiography.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cerebrospinal fluid progesterone in pregnant women.
To assess the possible relationship between an increase in progesterone concentration in cerebrospinal fluid (CSF) and enhancement of spread of spinal anaesthesia, we have measured CSF progesterone concentrations in 134 patients undergoing spinal anaesthesia with hyperbaric amethocaine 8 mg. Patients were allocated to one of five groups according to the gestational period: non-pregnant group (n = 13), first trimester group (8-12 weeks, n = 16), second trimester group (13-24 weeks, n = 18), third trimester group (25-36 weeks, n = 38) and term group (37-41 weeks, n = 49). Progesterone concentration in CSF was higher in the third trimester and term groups than in the non-pregnant, first trimester and second trimester groups. ⋯ Although an increase in CSF progesterone concentration in the second trimester group was similar in magnitude to that observed in the first trimester group, enhanced spread of spinal anaesthesia, comparable in magnitude with that observed in the term group, occurred in the second trimester group. There was no significant correlation between CSF progesterone concentration and spread of spinal anaesthesia in any of the groups. These data suggest that not only a minimum level of progesterone in CSF but also a certain duration of exposure to elevated CSF progesterone concentrations may be necessary for enhancement of spread of spinal anaesthesia, and that values of CSF progesterone concentration do not correlate directly with enhancement of spread of spinal anaesthesia.