British journal of anaesthesia
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We report a case of successful management of transfusion-related acute lung injury (TRALI) with prolonged cardiopulmonary bypass support in a 4-yr-old patient undergoing elective cardiac surgery. TRALI was diagnosed clinically and immunologically by detection of reactive antibodies in a unit of fresh frozen plasma that had been administered to the patient. The aetiology and management of TRALI are briefly discussed and possible implications of this case for the management of TRALI are highlighted.
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The motivation for this study was the current difficulty in estimating the total age-related MAC for a patient in a clinical setting. ⋯ The iso-MAC charts show clearly how patient age can be used to guide the choice of end-expired agent concentration. They also allow a consistent total MAC to be maintained when changing the inspired nitrous oxide concentration, thereby reducing the chance of inadvertent awareness, particularly at the extremes of age.
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Cardioventilatory coupling is the triggering of inspiratory onset by preceding cardiac activity. We have observed two forms of coupling with a bimodal ('quantal') variation of respiratory period. ⋯ Cross correlation analysis suggested that when pattern III was present, TI was dependent upon the preceding TE, which differs markedly from traditional views on the interaction between inspiratory and expiratory duration. VT was linearly related to TI, and so could also be determined by the preceding TE during this type of coupling.