European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
The influence of perioperative oxygen concentration on postoperative lung function in moderately obese adults.
Obesity aggravates the negative effects of general anaesthesia and surgery on the respiratory system, resulting in decreased functional residual capacity and expiratory reserve volume, and increased atelectasis and ventilation/perfusion (Va/Q) mismatch. High-inspired oxygen concentrations also promote atelectasis. This study compares the effects of perioperative inspired low-oxygen and high-oxygen concentrations on postoperative lung function and pulse oximetry values in moderately obese patients (BMI 25-35). ⋯ We conclude that postoperative lung function and arterial saturation is better preserved by a low-oxygen strategy, although it is not clear whether this has clinical relevance for the prevention of postoperative pulmonary complications.
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Accurate assessment of a patient's volume status is an important goal for an anaesthetist. However, most variables assessing fluid responsiveness are either invasive or technically challenging. This study was designed to compare the accuracy of arterial pressure-based stroke volume variation (SVV) and variations in the pulse oximeter plethysmographic waveform amplitude as evaluated with the noninvasive calculated pleth variability index (PVI) with central venous pressure to predict the response of stroke volume index (SVI) to volume replacement in patients undergoing major surgery. ⋯ Although arterial pressure-derived SVV revealed the best correlation to volume-induced changes in SVI, the results of our study suggest that both variables, SVV and PVI, can serve as valid indicators of fluid responsiveness in mechanically ventilated patients undergoing major surgery.
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Comparative Study
Cardiac output derived from arterial pressure waveform analysis without calibration vs. thermodilution in septic shock: evolving accuracy of software versions.
We studied the evolution of software in the accuracy of the FloTrac/Vigileo system to measure cardiac output less invasively from arterial pressure waveform analysis without calibration, in comparison with pulmonary artery catheter-derived thermodilution measurements, in patients with septic shock and presumed alterations in vascular tone. ⋯ Evolving software versions are thus better able to account for the effect of vascular tone on cardiac output measurements by less invasive waveform analyses without calibration (FloTrac/Vigileo), so that the latter may become useful in the haemodynamic monitoring of septic shock.
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The present study investigated whether positioning of the heart during off-pump coronary artery bypass grafting leads to changes in regional cerebral oxygen saturation measured by near infrared spectroscopy. ⋯ Positioning of the heart during off-pump coronary artery bypass grafting leads to a decrease in regional cerebral oxygen saturation. This decrease is associated with changes in cardiac output, haemoglobin concentration, arterial CO2 partial pressure, and central venous pressure.
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Letter Case Reports
Spinal anaesthesia and neuromyelitis optica: cause or coincidence?