British journal of anaesthesia
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Current practice at high-frequency oscillatory ventilation (HFOV) initiation is a stepwise increase of the constant applied airway pressure to achieve lung recruitment. We hypothesized that HFOV would lead to more adverse cerebral haemodynamics than does pressure controlled ventilation (PCV) in the presence of experimental intracranial hypertension (IH) and acute lung injury (ALI) in pigs with similar mean airway pressure settings. ⋯ In animals with elevated ICP and ALI, both ventilatory modes had effects upon cerebral haemodynamics. The effects upon cerebral haemodynamics were dependent of the P(T) level without differences between both ventilatory modes at similar P(mean) settings. HFOV seems to be a possible alternative ventilatory strategy when MAP deterioration can be avoided.
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The goal of the study was to determine activated thrombelastographic (TEG(R)) parameters with the rotational TEG(R) (ROTEG or ROTEM) device (Pentapharm GmbH, Munich, Germany) in neonates and infants <1 yr with complex congenital heart disease (CCHD) and to compare them with those of healthy children. ⋯ These preliminary TEG results indicate that the coagulation-fibrinolytic system in CCHD patients <1 yr is functionally intact and balanced but at a lower level than in healthy children. This could be interpreted as a reduction in the haemostatic potential with less reserve.
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Treatment of neuropathic pain remains a challenge. The current study investigated the therapeutic effect of intrathecal administration of NF-kappaB antisense oligodeoxynucleotides (ODNs) on mechanical allodynia and thermal hyperalgesia in a chronic constriction injury (CCI) model of rats. ⋯ The activation of NF-kappaB pathway may contribute to neuropathic pain in CCI rats. Suppression of NF-kappaB could be a potential new strategy for the treatment of neuropathic pain.
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Hypoxaemia during apnoea develops earlier and progresses faster in children than in adults. Ethical and practical considerations prevent detailed investigation of the issue. ⋯ Preoxygenation had a substantial effect on the speed of early desaturation, but less effect on the time for SaO2 to decrease from 90 to 40%. Preoxygenation substantially delayed dangerous desaturation in all age groups, although the rapidity of denitrogenation in the very young (caused by the large ratio of minute ventilation to functional residual capacity) resulted in lengthy preoxygenation having little benefit over brief preoxygenation. Airway obstruction during apnoea accelerated every child's hypoxaemia through prevention of mass flow addition to oxygen stores and through intrathoracic depressurization. On average, haemoglobin desaturation from SaO2 90 to 40% was 33% min(-1) with an obstructed airway and 26% min(-1) with an open airway; all ages were similarly susceptible to this effect.