British journal of anaesthesia
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Randomized Controlled Trial
Remifentanil-sevoflurane interaction models of circulatory response to laryngoscopy and circulatory depression.
Sevoflurane and remifentanil are commonly combined to produce the hypnotic and analgesic effects required for clinical anaesthesia. Previous studies have characterized interactions between several i.v. drugs and inhalation agents. Aiming to extend this effort, we developed two new mathematical models to characterize the interactions manner and strength between sevoflurane and remifentanil. ⋯ The new models can be used to characterize the interactions between these two drugs both qualitatively and quantitatively. Remifentanil significantly decreased the amount of sevoflurane required to eliminate patient response to clinical stimuli, thus reducing the likelihood of side-effects, specifically circulatory depression.
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Debate on appropriate triggers for transfusion of allogeneic blood products and their effects on short- and long-term survival in surgical and critically ill patients continue with no definitive evidence or decisive resolution. Although transfusion-related immune modulation (TRIM) is well established, its influence on immune competence in the recipient and its effects on cancer recurrence after a curative resection remains controversial. An association between perioperative transfusion of allogeneic blood products and risk for recurrence has been shown in colorectal cancer in randomized trials; whether the same is true for other types of cancer remains to be determined. This article focuses on the laboratory, animal, and clinical evidence to date on the mechanistic understanding of inflammatory and immune-modulatory effects of blood products and their significance for recurrence in the cancer surgical patient.
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The rapid reversal of the effects of vitamin K antagonists is often required in cases of emergency surgery and life-threatening bleeding, or during bleeding associated with high morbidity and mortality such as intracranial haemorrhage. Increasingly, four-factor prothrombin complex concentrates (PCCs) containing high and well-balanced concentrations of vitamin K-dependent coagulation factors are recommended for emergency oral anticoagulation reversal. Both the safety and efficacy of such products are currently in focus, and their administration is now expanding into the critical care setting for the treatment of life-threatening bleeding and coagulopathy resulting either perioperatively or in cases of acute trauma. ⋯ In general, four-factor PCCs have proven to be well tolerated and highly effective in the rapid reversal of vitamin K antagonists.