British journal of anaesthesia
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Randomized Controlled Trial
Remifentanil during cardiac surgery is associated with chronic thoracic pain 1 yr after sternotomy.
Chronic thoracic pain after cardiac surgery is a serious condition affecting many patients. The aim of this study was to identify predictors for chronic thoracic pain after sternotomy in cardiac surgery patients by analysing patient and perioperative characteristics. ⋯ In this follow-up study in cardiac surgery patients, intraoperative remifentanil was predictive for chronic thoracic pain in a dose-dependent manner. Randomized studies designed to evaluate the influence of intraoperative remifentanil on chronic thoracic pain are needed to confirm these results.
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Randomized Controlled Trial
Effect of the carrier solution for hydroxyethyl starch on platelet aggregation and clot formation.
Hydroxyethyl starch (HES) solutions alter blood coagulation, mainly platelet function and fibrinogen polymerization. Haemostasis can also be impaired by dilutional-hyperchloraemic acidosis induced by the HES carrier solution. We hypothesized that a saline-based tetrastarch carrier solution impairs parameters of blood coagulation more than a balanced carrier solution. ⋯ The carrier solution for HES up to 20 ml kg(-1) had little impact on platelet aggregation or clot formation as assessed by MEA and rotational thrombelastometry, respectively. Further clinical studies are required to verify this finding in patients and to correlate results of whole blood aggregometry and rotational thrombelastometry with perioperative bleeding and transfusion requirements.
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Review Meta Analysis
Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis.
Pathophysiological changes due to obesity may complicate mechanical ventilation during general anaesthesia. The ideal ventilation strategy is expected to optimize gas exchange and pulmonary mechanics and to reduce the risk of respiratory complications. ⋯ The ideal intraoperative ventilation strategy in obese patients remains obscure. There is some evidence that RM added to PEEP compared with PEEP alone improves intraoperative oxygenation and compliance without adverse effects. There is no evidence of any difference between PCV and VCV.
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Randomized Controlled Trial Comparative Study
Lung isolation in the morbidly obese patient: a comparison of a left-sided double-lumen tracheal tube with the Arndt® wire-guided blocker.
Obese patients are at risk of complications during airway management including difficult tracheal intubation. There are no reports regarding the ease of intubation or efficiency of lung collapse with the use of lung isolation devices for the morbidly obese patient. We conducted a prospective, randomized study in morbidly obese patients undergoing one-lung ventilation. We compared the effectiveness and ease of placement of a left-sided double-lumen tube and the Arndt(®) blocker. ⋯ There is no overall advantage of one device over the other during intubation of the morbidly obese patient.