Adv Clin Exp Med
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Randomized Controlled Trial Comparative Study
Sevoflurane vs. TIVA in terms of middle ear pressure during laparoscopic surgery.
The aim of this study was to investigate the effects of CO2 insufflation on the pressure of the middle ear cavity (PMEC) during laparoscopic surgery under total intravenous anesthesia (TIVA) with propofol or sevoflurane as an inhalational anesthetic maintenance. ⋯ Our results indicate that, in laparoscopic surgery, TIVA used for the maintenance of anesthesia did not increase the PMEC and the changes caused by sevoflurane were also in the normal range of middle ear pressures. In patients with previous ear surgery, if there is a need of classical surgical procedures in the future, sevoflurane anesthesia should not be the first choice due to its effects on PMEC, which cause it to be increased over 50 daPa, especially at 30 min after intubation. Patient characteristics including previous ear surgery should be considered in selecting the optimum anesthetic agents and technique.
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To evaluate the prevalence of medicines and psychoactive substances in the blood of drivers. ⋯ In the group of psychoactive substances most often used, either alone or in combination with other agents, there were tetrahydrocannabinols, whose high percentage of positive results in drivers stopped for a roadside control may be explained by commissioning studies on early screening. Concentrations of the substances in most cases did not exceed toxic levels. Roadside examinations, on the basis of their alcohol-like effect, were performed primarily on male drivers.
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Movement disorders and atrophy occur in the diaphragm, the most important muscle of respiration, because of mechanical ventilation (MV). ⋯ In our study, it was shown that atrophy occurred in the diaphragms of rats after MV, and the atrophy was decreased after theophylline administration.
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Pulmonary embolism (PE) is a relatively common and potentially life threatening clinical condition with estimated prevalence to be 0.4%. Early diagnosis of PE followed by adequate treatment reduces the risk of major complications. Multislice computed tomography pulmonary angiography (CTPA) currently constitutes an imaging modality of choice in patients with suspicion of PE. Computed tomography venography (CTV) of lower limb veins and CTPA can be performed simultaneously, allowing for visualization of lower limb deep vein thrombosis (DVT). Additionally, dual energy CT scanners enable the evaluation of lung perfusion which is of high value in indirect detection of pulmonary arterial microembolisms. ⋯ The multislice CTPA is an extremely useful imaging modality in patients with clinical suspicion of PE. The examination enables not only the analysis of pulmonary vessels but also evaluation of pulmonary parenchyma and mediastinum. The collimation of 0.625 mm makes it possible to detect the small foci of peripheral embolism.
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Improvements in surgical techniques and perioperative management mean that more complex cardiac procedures are being performed on very young patients. ⋯ Prolonged CPB duration was related to more severe renal tubular injury and acute renal failure. Measurements of urinary kidney specific biomarkers in infants and children with a CPB duration of more than 150 min might help identify those at high risk for ARF.