British journal of anaesthesia
-
Multicenter Study
Covert stroke after non-cardiac surgery: a prospective cohort study.
Overt stroke after non-cardiac surgery has a substantial impact on the duration and quality of life. Covert stroke in the non-surgical setting is much more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac, non-carotid artery surgery. ⋯ NCT01369537.
-
Multicenter Study Observational Study
Perioperative assessment of regional ventilation during changing body positions and ventilation conditions by electrical impedance tomography.
Lung-protective ventilation is claimed to be beneficial not only in critically ill patients, but also in pulmonary healthy patients undergoing general anaesthesia. We report the use of electrical impedance tomography for assessing regional changes in ventilation, during both spontaneous breathing and mechanical ventilation, in patients undergoing robot-assisted radical prostatectomy. ⋯ Electrical impedance tomography was able to identify and quantify on a breath-by-breath basis circumscribed areas, so-called silent spaces, within healthy lungs that received little or no ventilation during general anaesthesia, capnoperitoneum, and different body positions. As these silent spaces are suggestive of atelectasis on the one hand and overdistension on the other, they might become useful to guide individualized protective ventilation strategies to mitigate the side-effects of anaesthesia and surgery on the lungs.
-
Observational Study
Microcirculatory changes in children undergoing cardiac surgery: a prospective observational study.
The effects of cardiac surgery on the microcirculation of children are unknown. The aim of this study was to assess the microcirculatory changes in children undergoing surgery for correction of congenital heart disease. ⋯ Microcirculatory variables have a different time-related trend in cyanotic and acyanotic children undergoing cardiac surgery. The storage time of transfused RBCs seems to negatively impact the microcirculation. Further and larger studies are warranted to prove the potential implications of this study.
-
Nociceptin in the peripheral circulation has been proposed to have an immunoregulatory role with regards to inflammation and pain. However, the mechanisms involved in its regulation are still not clear. The aim of this study was to investigate signalling pathways contributing to the regulation of the expression of nociceptin under inflammatory conditions. ⋯ Upregulation of nociceptin expression by PMA in MM6 cells involves several pathways. Underlying mechanisms involved in nociceptin expression may lead to new insights in the treatment of pain and inflammatory diseases.
-
The 4th National Audit Project of the Royal College of Anaesthetists' and Difficult Airway Society (NAP4) made recommendations to improve reliability and safety of airway management in hospitals. This survey examines its impact. ⋯ Publication of NAP4 was followed by changes in practice in the majority of responding departments within two yr. Improvements included improved provision of difficult airway equipment and more widespread routine use of capnography. The biggest change occurred in ICU; the impact on training nursing and junior staff was modest and here, significant safety gaps remain.