British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Reducing allogeneic transfusion in cardiac surgery: a randomized double-blind placebo-controlled trial of antifibrinolytic therapies used in addition to intra-operative cell salvage.
The transfusion of allogeneic red blood cells and allogeneic coagulation products is associated with risk to the patient and the depletion of an increasingly scarce resource. This prospective, randomized, double-blind, placebo-controlled trial investigated practices to avoid transfusion in patients undergoing first-time cardiac surgery. ⋯ When used in addition to intra-operative cell salvage, aprotinin is the most efficacious pharmacological therapy for reducing patient exposure to any allogeneic transfusion during first-time cardiac surgery.
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After aneurysmal subarachnoid haemorrhage (SAH), the clinical outcome depends upon the primary haemorrhage and a number of secondary insults in the acute post-haemorrhagic period. Some secondary insults are potentially preventable but prevention requires prompt recognition of cerebral or systemic complications. Currently, several neuro-monitoring techniques are available; this review describes the most frequently used techniques and discusses indications for their use, and their value in diagnosis and prognosis. ⋯ However, ischaemia at the tissue level can be detected by intracerebral microdialysis technique. Used together with the conventional monitoring systems, for example intracranial pressure measurements, transcranial Doppler ultrasound and modern neuro-imaging, direct assessment of biochemical markers by intracerebral microdialysis is promising in the advancement of neurointensive care of patients with SAH. A successfully implemented monitoring system provides answers but it also raises valuable new questions challenging our current understanding of the brain injury after SAH.
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This study prospectively determined the haemodynamic changes in the lower limb venous circulation during and shortly after elective abdominal surgery, performed under general anaesthesia. ⋯ A significant decrease in the volume flow, mean and minimum velocities was noted during and immediately after elective total abdominal hysterectomy under general anaesthesia in ASA I and II patients. Flow changes in early recovery mirrored or enhanced those noted intraoperatively. Despite venous flow attenuation, haemodynamic readjustments produced a significant and progressive enhancement of venous flow pulsatility during the course of the procedure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia.
The Bispectral Index (BIS) and spectral entropy of the electroencephalogram can be used to assess the depth of hypnosis. Ketamine is known to increase BIS in anaesthetized patients and may confound that index as a guide to steer administration of hypnotics. We compared the effects of ketamine on BIS, response entropy (RE) and state entropy (SE) during surgery under sevoflurane anaesthesia. ⋯ Ketamine administered under sevoflurane anaesthesia causes a significant increase in BIS, RE and SE without modification of the RE-SE gradient. This increase is paradoxical in that it is associated with a deepening level of hypnosis.