British journal of anaesthesia
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Controlled Clinical Trial
Effect of body mass index on the ED50 volume of bupivacaine 0.5% for supraclavicular brachial plexus block.
The aim of this study was to determine whether the ED(50) dose of bupivacaine 0.5% for supraclavicular brachial plexus block increases with increasing body mass index (BMI). ⋯ Our study demonstrates that the ED(50) of bupivacaine 0.5% does not increase with an increase in BMI. We found evidence of a possible inverse relationship between ED(50) and BMI.
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The administration of anti-platelet agents to surgical patients with a history of coronary artery disease or peripheral vascular disease represents an everyday challenge to anaesthesiologists when epidural anaesthesia or analgesia is to be considered. Practice guidelines suggest stopping clopidogrel at least 7 days before placing an epidural catheter. Withholding anti-platelet drugs represents a great risk to many of these patients. ⋯ No neurological complications were found as a result of placing an epidural catheter in patients actively taking clopidogrel. Owing to the small sample size, we cannot recommend the liberal use of epidural analgesia with ongoing clopidogrel administration at this time. Further prospective studies, with larger sample size, are needed in order to substantiate our findings.
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The steep (40 degrees ) Trendelenburg position optimizes surgical exposure during robotic prostatectomy. The goal of the current study was to investigate the combined effect of this position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during these procedures. ⋯ The combination of the prolonged steep Trendelenburg position and CO(2) pneumoperitoneum was well tolerated. Haemodynamic and pulmonary variables remained within safe limits. Regional cerebral oxygenation was well preserved and CPP remained within the limits between which cerebral blood flow is usually considered to be maintained by cerebral autoregulation.
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Pulse pressure variation (PPV) and stroke volume variation (SVV) are robust indicators of fluid responsiveness in mechanically ventilated supine patients. The aim of the study was to evaluate the ability of PPV and SVV to predict fluid responsiveness in mechanically ventilated patients in the prone position (PP) during scoliosis surgery. ⋯ PP induces a significant increase in PPV and SVV but does not alter their abilities to predict fluid responsiveness.