British journal of anaesthesia
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Clinical Trial
Do fluid administration and reduction in norepinephrine dose improve global and splanchnic haemodynamics?
We studied global and splanchnic haemodynamics in patients with septic shock, while reducing norepinephrine doses by progressive fluid loading administration. Ten patients (six female, four male, aged 39-86 yr, mean 61 yr) were assessed using a transpulmonary thermo-dye dilution technique to measure cardiac output, intrathoracic blood volume and total blood volume. Splanchnic blood flow was measured by the steady state indocyanine green technique using a hepatic venous catheter. ⋯ Gastric mucosal (PRCO2) increased from 7.5 (2.5) to 9.0 (2.8) kPa. The PCO2 gap, i.e. the difference between regional and end-tidal PCO2, increased from 3.1 (2.5) to 4.0 (2.9) kPa. Marked individual variation in responses suggests that norepinephrine dose reduction by fluid loading in patients with stabilized septic shock does not necessarily increase global or splanchnic blood flow.
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Transoesophageal echocardiography (TOE) is valuable for perioperative monitoring in patients at risk from haemodynamic disturbance. However, its use is not practicable in patients undergoing surgical procedures under regional anaesthesia. We describe two cases showing that transthoracic echocardiography (TTE) has the same advantages as TOE and thus may be valuable for monitoring awake patients. TTE should be considered when extended perioperative haemodynamic monitoring is needed but TOE is not possible.
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Quality assurance data were collected prospectively for children who were sedated (n = 922) or given general anaesthesia (n = 140) for magnetic resonance imaging (MRI) or computerized tomography (CT). The data included patient characteristics, concurrent medication, adequacy of sedation, adverse events and requirement for escalated care. The quality of scans was evaluated. ⋯ We conclude that sedation of children for MRI and CT is associated with risks of hypoxaemia and of inadequate or failed sedation. These adverse events were more likely to occur in older children, those with a higher ASA status and those in whom benzodiazepines had been used as sole sedatives. For a preselected high-risk group of children, general anaesthesia may make MRI and CT scans more successful with minimal adverse events.
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The complications of carotid endarterectomy (CEA) under cervical plexus blockade have yet to be fully evaluated. Two different cases are presented; both patients suffered sudden collapse following superficial and deep cervical plexus block in preparation for CEA. The causes, presenting signs and differential diagnoses are discussed. The safest cervical plexus anaesthetic block technique has not yet been established.
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We assessed the Bird T-Bird VS ventilator using a model lung constructed to standard 10651-1 of the International Standards Organization. We used different combinations of lung compliance and airway resistance to simulate normal and diseased adult and paediatric lungs. ⋯ The ventilator can be powered by mains electricity supply or battery and requires only optional compressed oxygen. The ventilator is suitable for the provision of advanced ventilatory support during prolonged patient transfer.