European journal of anaesthesiology
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Conventional evaluation of cardiovascular volume status by filling pressures is unreliable in critically ill patients. Measurements of left ventricular end diastolic area index by transoesophageal echocardiography and of intrathoracic blood volume index by dye indicator dilution are new approaches to this problem. In this study, different indices of cardiovascular volume status were analysed to define their relation during the pronounced haemodynamic changes associated with systemic inflammation after cardiopulmonary bypass. ⋯ Absolute values of all variables varied widely, with the only significant correlation found between CVP and PCWP. Changes in CVP and PCWP did not correlate with changes in left ventricular end diastolic area index or intrathoracic blood volume index. Provided simultaneous baseline measurements are available and a supranormal intrathoracic blood volume index compensates for the haemodynamic changes in systemic inflammation, left ventricular end diastolic area index and intrathoracic blood volume index may substitute for each other during the evaluation of cardiovascular volume status in patients with stable cardiac function.
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Letter Case Reports
Thoracotomy without opioids in a heroin addict maintained with oral methadone.
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Aprotinin is a proteinase inhibitor that reduces blood loss in total hip arthroplasty when administered in large doses. Little is known about the capability of smaller doses of aprotinin in reducing blood loss and transfusion needs in this surgical setting. ⋯ Neither the volume of red blood cells lost nor that of red blood cells transfused during hospitalization differed significantly between the patients who had and those who had not received aprotinin (520 +/- 406 vs. 549 +/- 394 mL and 463 +/- 379 vs. 475 +/- 367 mL; P = 0.49 and P = 0.76 respectively). These results suggest that small-dose aprotinin was not effective in reducing blood loss and transfusion needs in patients undergoing unilateral primary total hip replacement.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiovascular effects of Org 9487 under isoflurane anaesthesia in man.
The cardiovascular effects of Org 9487 during isoflurane anaesthesia have been evaluated using three doses around its ED90 for neuromuscular blockade, i.e. 1 mg kg-1, 2 mg kg-1 and 3 mg kg-1. Heart rate increased to 110%, 115% and 118% in patients receiving 1 mg kg-1, 2 mg kg-1 and 3 mg kg-1 respectively. There were no significant effects on systolic and diastolic blood pressures for the two lower dose groups. ⋯ Six patients experienced a transient increase in airway pressure after administration of Org 9487, which was accompanied by a decrease in oxygen saturation in two out of six subjects, but there was no audible wheezing. These episodes were self-limiting and required no treatment. There were no other adverse reactions to this drug during this study.