British journal of anaesthesia
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Postoperative residual curarization (PORC) after surgery is common and its detection has a high error rate. Artificial neural networks are being used increasingly to examine complex data. We hypothesized that a neural network would enhance prediction of PORC. ⋯ Neural network-based prediction, using readily available clinical measurements, is significantly better than human judgement in predicting recovery of neuromuscular function.
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Case Reports
Postoperative extracorporeal membrane oxygenation for severe intraoperative SIRS 10 h after multiple trauma.
A 34-yr-old male suffered multiple trauma in a road traffic accident. He required right thoracotomy and laparotomy to control exanguinating haemorrhage, and received 93 u blood and blood products. Intraoperatively, he developed severe systemic inflammatory response syndrome (SIRS) with coagulopathy and respiratory failure. ⋯ The patient was stabilized within 60 min and transferred to the intensive care unit. He was weaned off ECMO after 51 h. He had no haemorrhagic complications, spent 3 weeks in the intensive care unit, and has made a good recovery.
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Many preoperative factors can influence perioperative mortality in cardiac surgery. Because the perioperative use of beta-blocking agents may reduce perioperative cardiac complications in non-cardiac surgery, we considered the possibility that beta-blocking agents could improve survival in coronary surgery patients. ⋯ Increasing age and urgency of surgery are associated with greater mortality, whereas preoperative beta-blocking therapy is associated with less mortality. The characteristics of patients who received chronic beta-blockade did not differ significantly from those of patients who did not. The results suggest that chronic preoperative beta-blocker therapy reduces 30-day mortality in coronary surgery.
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We describe an adult patient with gastric volvulus caused by a congenital diaphragmatic hernia. Anaesthetic management was complicated by cardiovascular instability, respiratory distress and unexpectedly difficult intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol requirement for insertion of cuffed oropharyngeal airway versus laryngeal mask airway with and without fentanyl: a dose-finding study.
The cuffed oropharyngeal airway (COPA) is a modified Guedel-type oral airway with a cuff at its distal end. The objectives of this prospective, randomized study were to compare the COPA and the laryngeal mask airway (LMA) in terms of propofol requirement with and without fentanyl pretreatment for smooth insertions. ⋯ Insertion of the COPA can be accomplished with a smaller bolus dose of propofol compared with the LMA, but propofol requirements are similar with both devices after a small dose of fentanyl.