British journal of anaesthesia
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Prehabilitation aims to reduce the impact of major surgery by improving the physical and psychological resilience of patients. Although exercise represents one component of prehabilitation, nutritional and psychological support are also critical to its effectiveness, and any benefits are only likely to be realised if the different components are implemented together, ideally in a behaviour change framework. Implementation of prehabilitation in cardiac surgery has not been as widespread as in other types of surgery, despite many randomised controlled trials (RCTs) of single interventions in this setting. ⋯ This was mostly not done for prehabilitation in noncardiac surgery, where programmes were implemented largely without trials of these combined interventions. The most likely chance of an effective prehabilitation programme for cardiac surgery is to combine all the efficacious and implementable single interventions together in one comprehensive evidence-based programme. This should then be tested in an adequately powered multicentre RCT in a representative cardiac surgery population.
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Surgery can induce severe neuroinflammation and negative emotional symptoms, such as anxiety-like behaviour. We studied whether reactive astrocytes in the zona incerta (ZI) mediate surgery-induced anxiety in mice. ⋯ Reactive astrocytes in the zona incerta mediate surgery-induced anxiety, possibly by regulating GAT-3-mediated GABA homeostasis and inactivating ZIGABA→median raphe nucleus projections in mice.
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This study aimed to assess whether a driving pressure-limiting strategy based on positive end-expiratory pressure (PEEP) titration according to best respiratory system compliance and tidal volume adjustment increases the number of ventilator-free days within 28 days in patients with moderate to severe acute respiratory distress syndrome (ARDS). ⋯ NCT04972318.
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Morphine and hydromorphone have differing onsets, magnitudes, and durations of effects and side-effects. Differences between opioids in their interindividual variabilities in pharmacokinetics and pharmacodynamics might influence rational drug selection. Crossover drug studies can provide more informative interindividual variability data than parallel group studies. Using data from a crossover study of i.v. morphine and hydromorphone in healthy volunteers, we tested the hypothesis that morphine and hydromorphone differ in their interindividual pharmacokinetic variability. ⋯ Morphine and hydromorphone did not differ in a statistically significant or clinically meaningful manner in their interindividual pharmacokinetic variability. Interindividual pharmacokinetic variability does not appear a meaningful consideration in the choice between these two opioids.