British journal of anaesthesia
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Comparative Study
Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery.
Assessment of cardiac output (CO) by the FloTrac/Vigileo system may offer a less invasive means of determining the CO than either the pulmonary artery catheter (PAC) or the PiCCOplus system. The aim of this study was to compare CO measurements made using the FloTrac/Vigileo system with upgraded software (FCO, Edwards Lifesciences, Irvine CA, USA), the PiCCOplus system (PCO, Pulsion Medical Systems, Munich, Germany) and continuous CO monitoring using a PAC (CCO; Vigilance monitoring, Edwards Lifesciences, Irvine CA, USA) with intermittent pulmonary artery thermodilution (ICO). The study was conducted in patients undergoing elective cardiac surgery. ⋯ The performance of the FloTrac/Vigileo system, the PiCCOplus, and the Vigilance CCO monitoring for CO measurement were comparable when tested against intermittent thermodilution in patients undergoing elective cardiac surgery.
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The reticular and thalamocortical system is known to play a prominent role in spindle wave activity, and the spindle wave is related to the sedative effects of anaesthetics. Recently, bispectral analysis of the EEG has been developed as a better method to indicate nonlinear regulation including the thalamocortical system linking to the cortical area. In the present study, in order to explore the interference of ketamine with the nonlinear regulation of the sub-cortical system, we examined the effect of ketamine on spindle alpha waves through the bispectral analysis. ⋯ Ketamine shifted the alpha peaks of bicoherence induced by propofol to higher frequencies. This suggests that ketamine changes the alpha spindle rhythms through the modulation of the nonlinear sub-cortical reverberating network.
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Multicenter Study
Assessment of healthcare professionals' knowledge of managing emergency complications in patients with a tracheostomy.
Ear, nose, and throat (ENT) surgeons perform the majority of surgical tracheostomies. Intensive care anaesthetists are increasingly performing bedside percutaneous tracheostomy. The objectives of this study were to characterize emergency complications of tracheostomy and to ascertain healthcare professionals' knowledge of life-saving strategies for the patient with a tracheostomy. ⋯ Knowledge of tracheostomy-related emergencies appears to be insufficient among non-ENT healthcare professionals. This needs to be addressed in order to maximize patient safety.
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The effects of pressure-controlled (PC) ventilation on the ventilatory and haemodynamic parameters during laparoscopy procedures had not been carefully assessed. This prospective cross-over study was undertaken to compare how volume-controlled (VC) and PC modes could affect pulmonary mechanics, gas exchange, and cardiac function in patients undergoing laparoscopy. ⋯ In this study, no short-term beneficial effect of PC ventilation could be demonstrated over conventional VC ventilation in patients with pneumoperitoneum.
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Corrected flow time (FTc) by oesophageal Doppler is considered to be a 'static' preload index. We evaluated the ability of FTc to predict fluid responsiveness and compared this with the abilities of other preload indices, such as pulse pressure variation (PPV), central venous pressure (CVP), and left ventricular end-diastolic area index (LVEDAI). ⋯ In this study, FTc predicted fluid responsiveness. However, FTc should be used in conjunction with other clinical information.