British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm.
Controversy exists regarding the optimal i.v. fluids for use with a goal-directed haemodynamic algorithm. ⋯ Using a goal-directed haemodynamic algorithm to optimize stroke volume, a balanced HES solution is associated with better haemodynamic stability and reduced need for fresh-frozen plasma. There were no signs of renal impairment by colloid solutions when fluid administration is targeted to optimize cardiac preload.
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In patients receiving an infusion of norepinephrine, the relationship between the amplitude of the oximeter plethysmographic waveform and stroke volume may be variable and quality of the waveform might be reduced, compared with patients not receiving norepinephrine. We assessed the reliability of the pleth variability index (PVI), an automatic measurement of the respiratory variation of the plethysmographic waveform, for predicting fluid responsiveness in patients receiving norepinephrine infusions. ⋯ PVI was less reliable than PPV and SVV for predicting fluid responsiveness in critically ill patients receiving norepinephrine. In addition, PVI could not be measured in a significant proportion of patients. This suggests that PVI is not useful in patients receiving norepinephrine.
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Randomized Controlled Trial
Long-term quality of sleep after remifentanil-based anaesthesia: a randomized controlled trial.
Clinical and pre-clinical data agree that opioids disrupt sleep architecture. Recently, remifentanil has been suggested to cause possible long-term disturbances of sleep quality. This randomized controlled clinical trial was designed to substantiate or refute a possible long-term effect of remifentanil on the quality of sleep. ⋯ The intraoperative use of remifentanil in a general patient population does not significantly alter the quality of sleep in the postoperative period. However, it may result in a significant reduction in the quality of sleep in patients before operation considered good sleepers. These changes were not observed in the group of patients receiving fentanyl. The relevance of these findings in terms of patient recovery and quality-of-life warrants further investigation. Trial Registration. ACTRN12610000362099.
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In a previous study, the authors found a large bias (50%) for lithium (LiDCO) compared with thermodilution cardiac output measurement methods in ponies receiving i.v. infusions of xylazine, ketamine, and midazolam. This prompted the authors to examine the effect of drugs on the LiDCO sensor. ⋯ A number of drugs influenced the accuracy of the LiDCO sensor in vitro but, based on published pharmacokinetic data, only xylazine, ketamine, lidocaine, and rocuronium may cause biases at clinically relevant concentrations. These findings need to be confirmed in vivo. Relevant (>3 mV) changes in sensor voltages due to the presence of drugs may indicate possible interactions with the LiDCO sensor.
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Randomized Controlled Trial
Intraoperative tissue oxygenation and postoperative outcomes after major non-cardiac surgery: an observational study.
The relationship between tissue oxygen saturation (StO(2)) and serious postoperative complications remains unclear. We tested the hypothesis that perioperative in patients undergoing major non-cardiac surgery is inversely related to serious surgical outcomes. ⋯ Minimum perioperative peripheral tissue oxygenation predicted a composite of major complications and mortality from major non-cardiac surgery. This is an observational association and whether clinical interventions to augment tissue oxygenation will improve outcomes remains to be determined.