British journal of anaesthesia
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Randomized Controlled Trial
Comparative effects of propofol vs dexmedetomidine on cerebrovascular carbon dioxide reactivity in patients with septic shock.
The use of sedative drugs is reportedly related to altered cerebrovascular CO2 reactivity. The present study examined the comparative effects of propofol vs dexmedetomidine on cerebrovascular CO2 reactivity in patients with septic shock. ⋯ This study showed that cerebrovascular CO2 reactivity was lower under dexmedetomidine sedation than under propofol sedation during almost identical sedation in patients with septic shock.
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Intensive care unit (ICU) re-admission identifies a high-risk group in terms of hospital mortality, length of stay, and resource utilization. Only hospital and ICU mortality are well described in the literature on critically ill patients needing re-admission. ⋯ Although the ICU, hospital, and subsequent mortalities are high in patients after ICU re-admission, most survivors at 2-3 yr had by then made a good functional recovery and were independent.
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Case Reports
Evidence of pulmonary aspiration during difficult airway management of a morbidly obese patient with the LMA CTrach.
We describe a pulmonary aspiration that occurred during tracheal intubation with the LMA CTrach (SEBAC, Pantin, France) in a male morbidly obese patient (178 cm height, BMI=48 kg m(-2)) admitted for elective gastric banding. Our report suggests that manipulations of the CTrach such as Up-manoeuvre may lead to pulmonary aspiration in the case of regurgitated gastric content.
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Comparative Study
Delta down compared with delta pulse pressure as an indicator of volaemia during intracranial surgery.
Delta pulse pressure (DPP) and delta down (DD) are indicators of volaemia. The threshold value of DPP for discriminating between responders and non-responders to fluid loading (FL) is 13%. This study aimed at comparing DD with DPP during intracranial surgery. ⋯ DD is as efficient as DPP to assess hypovolaemia and predict responsiveness to FL in patients undergoing intracranial surgery. A 5 mm Hg DD value can be considered as a valuable threshold for initiating FL. These results support its use during intracranial surgery.
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Errors in the judgement of puncture level during neuraxial anaesthesia can lead to significant complications. The aim of this study was to assess, in obstetric anaesthesia, the accuracy of clinical determination of the lumbar spinal interspace level, using surface ultrasound imaging as control. ⋯ The observed differences between clinical and ultrasonic identification of spinal puncture level highlight the potential for serious complications associated with the performance of neuraxial blocks above the spinous process of L3 in the parturient. With the increase in popularity of techniques involving puncture of the dura mater for labour anaesthesia, we feel that awareness of this risk is important.