British journal of anaesthesia
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Case Reports
A multi-dimensional analysis of genotype-phenotype discordance in malignant hyperthermia susceptibility.
Malignant hyperthermia (MH) susceptibility is an inherited condition, diagnosed either by the presence of a pathogenic genetic variant or by in vitro caffeine-halothane contracture testing. Through a multi-dimensional approach, we describe the implications of discordance between genetic and in vitro test results in a patient with a family history of possible MH. ⋯ Available data do not confirm or exclude an increased risk of MH for this patient. Further research is needed to correlate RyR1 functional assays, including the current gold standard testing for MH susceptibility, with clinical phenotypes. The pathogenicity of genetic variants associated with MH susceptibility should be re-evaluated.
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Randomized Controlled Trial
Cerebral blood flow alterations associated with high volume caudal block in infants.
High-volume (1.5 ml kg-1) caudal block in infants results in major reductions of cerebral blood flow velocity (CBFV) and cerebral oxygenation, caused by rostral CSF movement which increases intracranial pressure. The primary aim of this study was to determine the relationship between injected volume and CBFV changes. We hypothesised that this volume-blood flow relationship would have a similar albeit inverted shape to the well-known intracranial pressure volume-pressure curve. ⋯ Injection pauses appear to attenuate adverse CBFV increases during administration of a high-volume caudal block.
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The limited applicability of evidence from RCTs in real-word practice is considered a potential bottleneck for evidence-based practice but rarely systematically assessed. Using our failure to recruit patients into a perioperative beta-blocker trial, we set out to analyse the restrictiveness and generalisability of trial eligibility criteria in a real-world cohort. ⋯ EudraCT#: 2015-002366-23.
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Letter Observational Study
Outcomes in mechanically ventilated patients with hypoxaemic respiratory failure caused by COVID-19.