Anaesthesia
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Randomized Controlled Trial Comparative Study
An evaluation of underbody forced-air and resistive heating during hypothermic, on-pump cardiac surgery.
We conducted a randomised controlled trial to compare the efficacy of underbody forced-air warming (Arizant Healthcare Inc, Eden Prairie, MN, USA) with an underbody resistive heating mattress (Inditherm Patient Warming System, Rotherham, UK) and passive insulation in 129 patients having hypothermic cardiac surgery with cardiopulmonary bypass. Patients were separated from cardiopulmonary bypass at a core temperature of 35 °C and external warming continued until the end of surgery. ⋯ After cardiopulmonary bypass, the rate of rewarming was significantly greater with forced-air than with resistive warming or passive insulation (p < 0.001 for each), while resistive warming did not differ from passive insulation (p = 0.14). However, absolute temperature differences among the groups were small.
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Case Reports
Hyperglycaemia and cerebral oedema in a patient with a meningioma receiving dexamethasone.
Dexamethasone is prescribed routinely to reduce cerebral oedema in neurosurgical patients undergoing craniotomy for tumour and is used increasingly as an anti-emetic. Dexamethasone, however, has been shown to cause hyperglycaemia. We describe a case of hyperglycaemic crisis, cerebral oedema and death secondary to dexamethasone in a patient with a frontal meningioma. We highlight the risks of peri-operative dexamethasone and discuss the diagnosis, treatment and complications of hyperglycaemic crises and cerebral oedema.
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Editorial Comment Historical Article
Evidence-based critical care medicine: seeing through a glass darkly.
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Comment Letter Case Reports
The Clarus Video System as a useful diagnostic tool.