British journal of anaesthesia
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Comparative Study
Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery.
Assessment of cardiac output (CO) by the FloTrac/Vigileo system may offer a less invasive means of determining the CO than either the pulmonary artery catheter (PAC) or the PiCCOplus system. The aim of this study was to compare CO measurements made using the FloTrac/Vigileo system with upgraded software (FCO, Edwards Lifesciences, Irvine CA, USA), the PiCCOplus system (PCO, Pulsion Medical Systems, Munich, Germany) and continuous CO monitoring using a PAC (CCO; Vigilance monitoring, Edwards Lifesciences, Irvine CA, USA) with intermittent pulmonary artery thermodilution (ICO). The study was conducted in patients undergoing elective cardiac surgery. ⋯ The performance of the FloTrac/Vigileo system, the PiCCOplus, and the Vigilance CCO monitoring for CO measurement were comparable when tested against intermittent thermodilution in patients undergoing elective cardiac surgery.
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The emergence of variant Creutzfeldt-Jakob disease (vCJD) prompted guidelines from the Department of Health that stress the use of disposable and protective equipment. This survey explores current methods of airway management for tonsillectomy in the UK and ascertains anaesthetists' current knowledge and opinions of the guidelines and of vCJD. ⋯ The survey demonstrates widespread non-compliance with and lack of knowledge of, national guidelines.
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Corrected flow time (FTc) by oesophageal Doppler is considered to be a 'static' preload index. We evaluated the ability of FTc to predict fluid responsiveness and compared this with the abilities of other preload indices, such as pulse pressure variation (PPV), central venous pressure (CVP), and left ventricular end-diastolic area index (LVEDAI). ⋯ In this study, FTc predicted fluid responsiveness. However, FTc should be used in conjunction with other clinical information.
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We report a case of lumbar radiculopathy after zygapophyseal joint injections for chronic low back pain. The management of the patient and potential causes for the radiculopathy are discussed. The case acts as a reminder that the spinal nerve roots should be considered when performing intra-articular facet joint injections and demonstrates the importance of including nerve injury in the patient consent process as a rare, but significant complication.
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Case Reports
Perioperative management of four anaemic female Jehovah's Witnesses undergoing urgent complex cardiac surgery.
Previous studies have demonstrated that preoperative haemoglobin concentration and female gender are related to an increased need for perioperative allogeneic transfusions in cardiac surgery. Hence, urgent cardiac surgery presents a dilemma for female patients who are Jehovah's Witnesses, because of their refusal of allogeneic transfusion. ⋯ In these Jehovah's Witness patients, strict application of a comprehensive blood-sparing protocol permitted safe avoidance of allogeneic transfusions. The protocol involved intraoperative acute normovolaemic haemodilution, intraoperative administration of tranexamic acid, intra- and postoperative use of a cell-saver system, postoperative administration of erythropoietin, iron and folic acid, and a careful surgical technique to avoid perioperative bleeding.