British journal of anaesthesia
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The incidence of asthma is increasing worldwide, but morbidity and mortality are decreasing because of improvements in medical care. Although the incidence of severe perioperative bronchospasm is relatively low in asthmatics undergoing anaesthesia, when it does occur it may be life-threatening. ⋯ Many routinely used anaesthetic agents have an ameliorative effect on airway constriction. Nonetheless, acute bronchospasm can still occur, especially at induction and emergence, and should be promptly and methodically managed.
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The aim of this prospective study was to determine whether a level of positive airway pressure was generated in participants receiving nasal high flow (NHF) delivered by the Optiflow system (Fisher and Paykel Healthcare Ltd, Auckland, New Zealand) in a cardiothoracic and vascular intensive care unit (ICU). ⋯ This study demonstrated that a low level of positive pressure was generated with NHF at 35 litre min(-1) of gas flow. This is consistent with results obtained in healthy volunteers. Australian Clinical Trials Registry www.actr.org.au ACTRN012606000139572.
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Patients with cardiovascular disease have an array of haemostasis disorders that predispose to the development of thrombotic and embolic disease states. These patients are often maintained on anti-thrombotic medication to prevent adverse cardiovascular events. ⋯ The following review introduces the monitors that are available for monitoring perioperative coagulation, with an emphasis on cardiovascular surgery. Heparin monitors, platelet function monitors for use in transfusion algorithms, and monitoring anti-platelet drugs will be discussed.
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Comparative Study
Comparison of a supra-sternal cardiac output monitor (USCOM) with the pulmonary artery catheter.
Cardiac output (CO) cannot reliably be estimated by clinical examination. We aimed to measure the agreement between CO measurements using a supra-sternal Doppler monitor (USCOM, Coffs Harbour, Australia) and the pulmonary artery catheter (PAC). ⋯ In our subjects, there was poor agreement between CO measurements done with the supra-sternal Doppler monitor and PAC.