British journal of anaesthesia
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Neurological deficit after repair of a thoracic or thoracoabdominal aortic aneurysm (TAA/TAAA) remains a devastating complication. The aim of our study was to investigate the clinical value of biochemical markers [S-100B, neurone-specific enolase (NSE) and lactate dehydrogenase (LD)], evoked potentials and their combinations for identifying adverse neurological outcome after TAA/TAAA surgery. ⋯ TcMEP monitoring during TAA/TAAA surgery seems to be an effective but not completely sufficient guide in our protective multi-modality strategy. Combinations of the serum concentrations of S-100B and tcMEP ratios during the early reperfusion period might be associated with adverse neurological complications. Furthermore, biochemical markers could detect central nervous system injury on the first postoperative day and may have prognostic value.
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Comparative Study
Performance of entropy and Bispectral Index as measures of anaesthesia effect in children of different ages.
Entropy and Bispectral Index (BIS) have been promoted as EEG-based anaesthesia depth monitors. The EEG changes with brain maturation, but there are limited published data describing the characteristics of entropy in children, and some data suggest that BIS is less reliable in young children. The aim of this study was to compare the performance of entropy as a measure of anaesthetic effect in different age groups. The performance of entropy was compared with BIS. ⋯ For both entropy and BIS the measure of anaesthetic effect was significantly different for children aged <1 yr compared with older children. There was no difference in performance of entropy and BIS. Both should be used cautiously in small children.
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Randomized Controlled Trial
Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea.
In obese patients, reduced functional residual capacity exacerbated by supine position might decrease the effectiveness of pre-oxygenation and the tolerance to apnoea. The aim of this study was to compare the effect of body posture during pre-oxygenation, sitting or supine, on its effectiveness in obese patients. ⋯ Pre-oxygenation in sitting position significantly extends the tolerance to apnoea in obese patients when compared with the supine position.
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Case Reports
Treatment of cardiogenic shock with levosimendan in combination with beta-adrenergic antagonists.
Levosimendan, a calcium sensitizer, was used in combination with beta-adrenergic antagonists in a man aged 56 yr with cardiogenic shock, complicating acute myocardial infarction, who developed severe tachycardia after dobutamine administration. The patient's trachea was intubated, his lungs were ventilated, and he was started on dopamine 5 microg kg(-1) min(-1) and dobutamine 5 microg kg(-1) min(-1), titrated to a mean arterial pressure > or =65 mm Hg. He progressively became tachycardiac (>120 beats min(-1)) with a cardiac index (CI) of 1.4 litre min(-1) m(-2) despite adequate preload. ⋯ Subsequently, HR decreased over time and both catecholamines were discontinued 14 h after starting levosimendan infusion. The trachea was extubated within 20 h and the patient was discharged to the ward on day 4 after admission. In conclusion, levosimendan in combination with a beta-adrenergic antagonist may have beneficial effects in patients with cardiogenic shock who exhibit tachycardia in response to inotropic agents.
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Ischaemia is one of the causative mechanisms of peripheral nerve injury, a documented complication of regional anaesthesia. Local anaesthetics per se and/or vasopressor adjuvants may account for changes in peripheral nerve blood flow. The aim of this study was to test the effects of levobupivacaine and ropivacaine in a rat sciatic nerve model with respect to local blood flow and histopathological changes. ⋯ Despite acute reductions in peripheral nerve blood flow, significant histopathological changes were not observed in this rat sciatic nerve model after topical application of levobupivacaine and ropivacaine at concentrations relevant to clinical practice.