BMC anesthesiology
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Clinical Trial Observational Study
Assessment of changes of regional ventilation distribution in the lung tissue depending on the driving pressure applied during high frequency jet ventilation.
Electrical impedance tomography (EIT) is a tool to monitor regional ventilation distribution in patient's lungs under general anesthesia. The objective of this study was to assess the regional ventilation distribution using different driving pressures (DP) during high frequency jet ventilation (HFJV). ⋯ In our study intraoperative EIT was an effective method of functional monitoring of the lungs during HFJV for rigid bronchoscopy procedure. Lower driving pressure was as effective in providing sufficient ventilation distribution through the lungs as the higher driving pressure but characterized by lower airway pressure.
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Case Reports
Acute heart failure after Orthotopic liver transplantation: a case series from one center.
Patients undergoing liver transplantation (LT) can develop acute heart failure (HF) in the postoperative period despite having had a normal cardiac evaluation prior to surgery. End-stage liver disease is often associated with underlying cardiac dysfunction which, while not identified during preoperative testing, manifests itself during or immediately after surgery. ⋯ Diastolic dysfunction, QTc interval prolongation, and an increase in BNP may be predictive of postoperative HF. Current recommendations for preoperative cardiovascular evaluation of transplant candidates does not include studies examining these risk factors and should be revised. Further investigations are necessary to evaluate these findings.
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Randomized Controlled Trial
Cost-effectiveness of anesthesia maintained with sevoflurane or propofol with and without additional monitoring: a prospective, randomized controlled trial.
We compared cost-effectiveness of anesthesia maintained with sevoflurane or propofol with and without additional monitoring, in the clinical setting of ear-nose-throat surgery. ⋯ Our study demonstrated that the use of BIS and TOF monitoring decreased the total cost of anesthesia drugs and hastened postoperative recovery. However, in our circumstances, these were associated with higher disposables costs. Detailed cost analysis and further investigations are needed to identify patient populations who would benefit most from additional monitoring.
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The increase in endotracheal tube cuff pressure due to nitrous oxide diffusion is a well-known risk during general anesthesia using nitrous oxide. We hypothesized that lubricating endotracheal tube cuffs with K-Y™ Jelly might inhibit the increase in cuff pressure that occurs during exposure to nitrous oxide. ⋯ Lubrication of endotracheal tube cuffs with K-Y™ Jelly may effectively delay the increase in cuff pressure that occurs during general anesthesia using nitrous oxide.
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Perioperative temperature management is fundamental to ensure normothermia in patients. Fluid warmers, which have become smaller in size over the past few years, can help to maintain a stable body temperature. Potentially, the reduction of the size may influence the heating performance. ⋯ The heating capability for room-tempered saline was effective in all tested devices, but with ice-cooled saline enFlow® is superior at high flow rates. At low flow rates the heating capabilities of enFlow®, Fluido compact® and Thermosens® are comparable.