British journal of anaesthesia
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Acute lung injury after oesophagectomy is well recognized but the risk factors associated with its development are poorly defined. We analysed retrospectively the effect of a number of pre-, peri- and post-operative risk factors on the development of lung injury in 168 patients after elective oesophagectomy performed at a single centre. The acute respiratory distress syndrome (ARDS) developed in 14.5% of patients and acute lung injury in 23.8%. ⋯ Features associated with the development of ARDS included a low pre-operative body mass index, a history of cigarette smoking, the experience of the surgeon, the duration of both the operation and of one-lung ventilation, and the occurrence of a post-operative anastomotic leak. Peri-operative cardiorespiratory instability (measured by peri-operative hypoxaemia, hypotension, fluid and blood requirements and the need for inotropic support) was also associated with ARDS. Acute lung injury after elective oesophagectomy is associated with intraoperative cardiorespiratory instability.
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Recent evidence has suggested that the rate of uptake of inhalational anaesthetic is constant during maintenance of anaesthesia, contrary to the predictions of multi-compartment uptake models. We measured isoflurane uptake using a totally closed anaesthetic system during up to 10 h of stable anaesthesia for maxillo-facial surgery on 12 adult patients. Liquid isoflurane was injected into the system under computer control to produce an end tidal concentration of 1.3 MAC of isoflurane. ⋯ Anaesthetic usage for a 70 kg patient was 0.44e(-0.51t)+0.044e(-0.013t)+0.058e(-0.00098t) ml min(-1) of liquid isoflurane, where t is duration of anaesthesia in minutes. There was a continuing reduction in anaesthetic requirement even at the end of the period of study that was statistically significant. These data do not support the notion that isoflurane uptake is constant during stable maintenance of anaesthesia but is compatible with the conventional multi-compartment model of anaesthetic uptake and distribution.