British journal of anaesthesia
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Comparative Study
Five algorithms that calculate cardiac output from the arterial waveform: a comparison with Doppler ultrasound.
Different mathematical approaches are used to calculate arterial pulse pressure wave analysis (PPWA) cardiac output. The CardioQ-Combi is a research oesophageal Doppler (COODM) monitor that includes these five fundamental PPWA algorithms. We compared these PPWA cardiac output readings to COODM and suprasternal USCOM Doppler (COUS) over a range of cardiac output values induced by dopamine infusion in patients undergoing major surgery. USCOM acted as a control. ⋯ The Liljestrand-Zander PPWA formula was most reliable compared with oesophageal Doppler in major surgical patients under general anaesthesia, but not better than USCOM.
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Observational Study
Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery†
Postoperative delirium is common in older patients. Despite its prognostic significance, the pathophysiology is incompletely understood. Although many risk factors have been identified, no reversible factors, particularly ones potentially modifiable by anaesthetic management, have been identified. The goal of this prospective cohort study was to investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing major non-cardiac surgery. ⋯ These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium.
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Bioreactance is a novel noninvasive method for cardiac output measurement that involves analysis of blood flow-dependent changes in phase shifts of electrical currents applied across the thorax. The present study evaluated the test-retest reliability of bioreactance for assessing haemodynamic variables at rest and during exercise. ⋯ The bioreactance method demonstrates good test-retest reliability for estimating cardiac output at rest and during different stages of graded exercise testing including maximal exertion.
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Postoperative nausea and vomiting (PONV) and fentanyl-induced cough (FIC) are two common anaesthesia-related events, which seem to have common risk factors. In this prospective cohort study, we investigate whether patients who have FIC during induction of anaesthesia have an increased incidence of PONV. ⋯ Non-smoking women undergoing gynaecological surgery who develop FIC during induction of anaesthesia have a higher incidence of PONV.
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We investigated whether cardiac output measured with pulse wave transit time (esCCO, Nihon Kohden, Tokyo, Japan) is able to track changes in cardiac output induced by an increase in preload (volume expansion/passive leg-raising) or by changes in vasomotor tone (variation in norepinephrine dosage) in critically ill patients. ⋯ esCCO was not able to track changes in cardiac output, induced by an increase in preload or by variations in vasomotor tone. Therefore, esCCO cannot guide haemodynamic interventions in critically ill patients.