European journal of anaesthesiology
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and objective Inflammatory liver dysfunction in rats leads to a prolonged vecuronium-induced neuromuscular blockade due to insufficient metabolism. A coexisting resistance against the drug partly counteracts this prolongation. The present study investigates the pharmacodynamics of atracurium whose metabolism does not depend on liver function. ⋯ A systemic inflammatory response syndrome with liver dysfunction results in decreased sensitivity to atracurium. Further investigations are needed regarding a possible up-regulation of acetylcholine receptors or an increased protein binding of atracurium during sepsis to clarify reasons behind this phenomenon.
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and objective The purpose of this study was to investigate retrospectively what factors contribute to the development of the type of hyperlactatemia which may follow cardiopulmonary bypass despite well-maintained oxygen delivery and a normal perioperative course. ⋯ It is suggested that the pathophysiology observed is based on impairment of tissue oxygen utilization. The duration of cardiopulmonary bypass and especially the occurrence of hypotension at the start of the bypass period appears to be related to the development of lactic acidosis.
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Comparative Study Clinical Trial
Hypotension during endotoxemia in aged humans.
and objective The aim of this study was to determine possible age-associated differences in human blood pressure regulation during an immunological challenge in healthy subjects. ⋯ In conclusion, healthy elderly subjects fail to maintain a constant mean arterial pressure in response to the immunological challenge of endotoxemia.
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A case is presented in which memory of events during emergence from anaesthesia resulted in serious psychological sequelae. Communication with patients should begin almost immediately after anaesthesia has been terminated and should have prevented this unfortunate incident.