British journal of anaesthesia
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Randomized Controlled Trial
Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery.
Intraoperative stress may suppress the adaptive immune system. Abolished proinflammatory lymphocyte function is associated with higher risk of infection and postoperative complications. We hypothesized that thoracic epidural anaesthesia (TEA) reduces intraoperative stress and thus attenuates lymphocyte decrease and impairment of proinflammatory lymphocyte function. ⋯ Intraoperative use of thoracic epidural catheter reduced stress response and prevented stress-induced perioperative impairment of proinflammatory lymphocyte function.
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Comparative Study
Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients.
Morbidity and mortality are higher in patients with poor preoperative cardiorespiratory reserve. This study aimed to ascertain fitness and therefore risk in elective patients, comparing three measures: Duke Activity Status Index (DASI) questionnaire, incremental shuttle walk test (ISWT), and cycle cardiopulmonary exercise testing (CPET). We looked for correlation between the measures and for thresholds on the questionnaire or shuttle test which could identify fit patients and render CPET unnecessary. ⋯ We found a significant correlation between the tests. However, many patients with poor questionnaire scores or shuttle walks had satisfactory CPET results. Hence, the ability of either simple test to determine risk in a heterogeneous surgical population is poor. CPET provides an objective measurement of cardiopulmonary fitness; however, evidence for this information improving patient outcome is limited and requires further research.
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Single-lung ventilation (SLV) during thoracic surgery causes important cardiopulmonary disturbances. Absolute cerebral oximetry was used to determine the incidence and magnitude of the decrease in cerebral oxygen saturation (Sct(o(2))) in patients undergoing SLV during thoracic surgery. ⋯ Thoracic surgery with SLV seems to be associated with a significant decrease of Sct(o(2)) in the majority of patients. Parameters such as peripheral oxygen saturation or Po(2) which are used to guide SLV during thoracic surgery are not sufficient to detect significant cerebral oxygen desaturations.
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Stroke volume variation (SVV) is able to predict adequately the individual response to fluid loading. Our objective was to assess whether the SVV measured by a new algorithm (Vigileo; Flotrac) can predict fluid responsiveness. ⋯ The SVV obtained by the Vigileo system may be used as a predictor of fluid responsiveness in patients with circulatory failure after liver transplantation. CO-Vigileo is able to track the change in CO induced by VE.
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Approximately 30-80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem. ⋯ We demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA.