Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled Trial Comparative StudyInhaled iloprost to control pulmonary artery hypertension in patients undergoing mitral valve surgery: a prospective, randomized-controlled trial.
Pulmonary hypertension (PHT) is common in patients undergoing mitral valve surgery and is an independent risk factor for the development of acute right ventricular (RV) failure. Inhaled iloprost was shown to improve RV function and decrease RV afterload in patients with primary PHT. However, no randomized-controlled trials on the intraoperative use of iloprost in cardiac surgical patients are available. We therefore compared the effects of inhaled iloprost vs. intravenous standard therapy in cardiac surgical patients with chronic PHT. ⋯ In patients with pre-existing PHT undergoing mitral valve surgery, inhaled iloprost is superior to intravenous nitrogylycerine by acting as a selective pulmonary vasodilator, reducing RV afterload and moderately improving RV-pump performance.
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled Trial Comparative StudyBispectral index monitoring: appreciated but does not affect drug dosing and hypnotic levels.
Bispectral index (BIS) has been associated with benefits from less-deep anesthesia as well as preventing awareness, albeit not at the same time. We investigated how increasing experience from BIS in clinical practice affect the hypnotic level, drug consumption, as well as subjective opinions on this monitoring. ⋯ Although BIS became considerably appreciated, growing experience and repeated education had no impact on drug dosing and BIS levels.
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled TrialChronic AT1-receptor blockade does not alter cerebral oxygen supply/demand ratio during cardiopulmonary bypass in hypertensive patients.
The angiotensin II receptor type 1 antagonist candesartan has been hypothesized to alter vasopressor requirements and brain-blood flow by changing cerebrovascular autoregulation. Therefore, we assessed the effects of a pre-anaesthetic treatment course with candesartan on cerebral arterial-jugular bulb oxygen content difference, middle cerebral artery blood velocity, and vasopressor requirements in hypertensive patients undergoing elective on-pump coronary artery bypass graft surgery. ⋯ Thus, a 6-8-day treatment course with candesartan does not alter global cerebral perfusion and oxygen supply/demand ratio during cardiopulmonary bypass, or vasopressor requirements in hypertensive patients undergoing on-pump coronary artery bypass graft surgery, and no deleterious consequences of AT1-receptor blockade were detected.
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled TrialAdministration of fentanyl before remifentanil-based anaesthesia has no influence on post-operative pain or analgesic consumption.
Remifentanil's short-acting analgesic effect and the potential of producing hyperalgesia is a challenge to post-operative pain control. This study investigated whether pre-treating the patients with fentanyl before remifentanil-based anaesthesia could reduce post-operative pain or analgesic consumption. ⋯ Pre-treatment with fentanyl 1.5 microg/kg IV yielded no reduction in post-operative pain or analgesic consumption after 90 min of remifentanil-based anaesthesia with 0.43 microg/kg/min of remifentanil.
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled Trial Comparative StudyDepth of anesthesia with desflurane does not influence the endocrine-metabolic response to pelvic surgery.
It has been reported that, with deep levels of anesthesia achieved with general anesthetic agents and opioids, post-operative consumption of morphine and pain intensity can be reduced. It is not clear whether the depth of anesthesia modifies pain intensity by influencing the endocrine-metabolic stress response. The purpose of this study was to assess the influence of a high concentration of desflurane on peri-operative plasma cortisol. ⋯ The results show that there is no relationship between the intra-operative level of anesthesia depth achieved with desflurane and the extent of endocrine-metabolic stress response.