British journal of anaesthesia
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Tissue-specific monoallelic silencing of the RYR1 gene has been proposed as an explanation for variable penetrance of dominant RYR1 mutations in malignant hyperthermia (MH). We examined the hypothesis that monoallelic silencing could explain the inheritance of an MH discordant phenotype in some instances. ⋯ Epigenetic allele silencing may play a role in the inheritance of MH susceptibility, but this is unlikely to involve silencing of RYR1.
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Intraperitoneal insufflation of carbon dioxide (CO2) may promote collapse of dependent lung regions. The present study was undertaken to study the effects of CO2-pneumoperitoneum (CO2-PP) on atelectasis formation, arterial oxygenation, and arterial to end-tidal PCO2-gradient (Pa-E'(CO2)). ⋯ Development of atelectasis during anaesthesia and PP may be estimated by an increased Pa-E'(CO2).
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Previous studies indicate that avoiding neuromuscular blocking agents (NMBAs) may be a risk factor for difficult tracheal intubation (DTI). We investigated whether avoiding NMBA was associated with DTI. ⋯ Avoiding NMBA may increase the risk of DTI. However, confounding by indication may be a problem in this observational study and systematic reviews with meta-analysis or more randomized clinical trials are needed.
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Existing indices of pulmonary oxygenation vary misleadingly with external factors such as inspired oxygen fraction (FI(O2)), arterial carbon dioxide tension (PaCO2), and haemoglobin (Hb). Previous work suggested that some indices may be acceptably useful in particular scenarios such as acute respiratory distress syndrome (ARDS) or where FI(O2)>60%. However, it is not possible to identify such scenarios in most clinical contexts; therefore we aimed to examine the induced variability of existing indices in a population of patients with a variety of lung defects. ⋯ No existing index of oxygenation adequately describes the severity of gas exchange defect. Existing indices of oxygenation vary with disease severity, disease type, and external factors such as FI(O2). A novel and robust index is needed.