Anaesthesia
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Esmolol has a beneficial effect on the T helper 1/T helper 2 balance in patients with heart failure. The aim of this study was to investigate the immunomodulatory role of esmolol during and after surgery. Patients undergoing laparoscopic gastrectomy due to gastric cancer were enrolled. ⋯ The esmolol group was associated with higher ratios of interferon-γ/interleukin-4 (T helper 1/T helper 2 signature cytokines) than the saline group during (2.36 vs 0.57, respectively, p = 0.041) and after (5.79 vs 0.69, respectively, p = 0.033) surgery. The postoperative increase in interleukin-6 was attenuated in the esmolol group, and the C-reactive protein level on postoperative day 1 was significantly lower in the esmolol group than in the saline group (mean (SD) 26.2 (18.3) mmol.l(-1) vs 56.8 (44.3) mmol.l(-1), p = 0.021). Our findings suggest that esmolol played an immunomodulatory role and mitigated the postoperative inflammatory response in patients under surgical and anaesthetic stress.
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Concise guidelines are presented that relate abnormalities of coagulation, whether the result of the administration of drugs or that of pathological processes, to the consequent haemorrhagic risks associated with neuraxial and peripheral nerve blocks. The advice presented is based on published guidelines and on the known properties of anticoagulant drugs. Four separate Tables address risks associated with anticoagulant drugs, neuraxial and peripheral nerve blocks, obstetric anaesthesia and special circumstances such as trauma, sepsis and massive transfusion.
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We investigated the effects of 10 cmH2O positive end-expiratory pressure on cerebral haemodynamics and cerebral oxygenation in patients undergoing laparoscopic lower abdominal surgery in the 30° Trendelenburg position during desflurane anaesthesia. Twenty-six patients were enrolled in this study. After anaesthesia induction, pneumoperitoneum was applied in Trendelenburg position. ⋯ There was no change in regional cerebral oxygen saturation (p = 0.376). Cerebral perfusion pressure decreased significantly over time (p < 0.001) and positive end-expiratory pressure caused a further decrease in cerebral perfusion pressure (p = 0.036). The application of 10 cmH2O positive end-expiratory pressure during pneumoperitoneum in the Trendelenburg position preserved regional cerebral oxygen saturation, but cerebral perfusion pressure decreased significantly due to its secondary haemodynamic effects.
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Deciding between a passive heat and moisture exchanger or active humidification depends upon the level of humidification that either will deliver. Published international standards dictate that active humidifiers should deliver a minimum humidity of 33 mg.l(-1); however, no such requirement exists, for heat and moisture exchangers. Anaesthetists instead have to rely on information provided by manufacturers, which may not allow comparison of different devices and their clinical effectiveness. ⋯ In this study, different types of heat and moisture exchangers for adults, children and patients with a tracheostomy were tested. Adult and paediatric models lost between 6.5 mg.l(-1) and 8.5 mg.l(-1) moisture (corresponding to an efficiency of around 80%); however, the models designed for patients with a tracheostomy lost between 16 mg.l(-1) and 18 mg.l(-1) (60% efficiency). I propose that all heat and moisture exchangers should be tested in this manner and percentage efficiency reported to allow an informed choice between different types and models.