British journal of anaesthesia
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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.
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Randomized Controlled Trial Comparative Study
Accuracy of non-invasive measurement of haemoglobin concentration by pulse co-oximetry during steady-state and dynamic conditions in liver surgery.
The Masimo Radical 7 (Masimo Corp., Irvine, CA, USA) pulse co-oximeter(®) calculates haemoglobin concentration (SpHb) non-invasively using transcutaneous spectrophotometry. We compared SpHb with invasive satellite-lab haemoglobin monitoring (Hb(satlab)) during major hepatic resections both under steady-state conditions and in a dynamic phase with fluid administration of crystalloid and colloid solutions. ⋯ SpHb correlated moderately with Hb(satlab) with a slight underestimation in both phases in patients undergoing major hepatic resection. Accuracy increased for lower Hb(satlab) values but decreased in the presence of colloid solution. Further improvements are necessary to improve device accuracy under these conditions, so that SpHb might become a sensitive screening device for clinically significant anaemia.
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This observational study was designed to evaluate the reliability and precision of a new digital photoplethysmographic device (Nexfin, BMEYE B.V., Amsterdam, The Netherlands) for continuous and non-invasive assessment of arterial pressure and cardiac output. ⋯ The Nexfin device is safe, convenient, and reliable in measuring continuous non-invasive arterial pressure but not interchangeable with transpulmonary thermodilution to monitor CI.
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This review discusses the role of microparticles in inflammation, coagulation, vascular function, and most importantly, their physiological and pathological functions in sepsis. Microparticles are proinflammatory, procoagulant membrane vesicles released from various cell types. They are detectable in normal individuals and basal levels correlate with a balance between cell proliferation, stimulation, and destruction. ⋯ Microparticles may in fact be beneficial in early sepsis, given that activated protein C bound to endothelium-derived microparticles retains anticoagulant activity, and increased circulating microparticles are protective against vascular hyporeactivity. Elevated levels of microparticles in early sepsis may therefore compensate for the host's systemic inflammatory response. Importantly, in vivo, septic microparticles induce deleterious changes in the expression of enzyme systems related to inflammation and oxidative stress, thus they may represent important contributors to multi-organ failure in septic shock.