British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Xenon or propofol anaesthesia for patients at cardiovascular risk in non-cardiac surgery.
The results of two European multi-centre trials on xenon anaesthesia led to the hypothesis that a xenon-based anaesthetic would keep left ventricular (LV) and circulatory function more stable than a propofol-based anaesthetic, in patients with coronary artery disease (CAD). ⋯ Xenon anaesthesia provided a higher arterial pressure level than propofol, with no signs of cardiovascular compromise, in patients with CAD. Echocardiographic indices showed better LV function with xenon.
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A multidisciplinary panel of physicians was convened by Network for Advancement of Transfusion Alternatives to review the evidence on the efficacy and safety of i.v. iron administration to increase haemoglobin levels and reduce blood transfusion in patients undergoing surgery, and to develop a consensus statement on perioperative use of i.v. iron as a transfusion alternative. After conducting a systematic literature search to identify the relevant studies, critical evaluation of the evidence was performed and recommendations formulated using the Grades of Recommendation Assessment, Development and Evaluation Working Group methodology. Two randomized controlled trials (RCTs) and six observational studies in orthopaedic and cardiac surgery were evaluated. ⋯ For all other types of surgery, no evidence-based recommendation can be made. The panel recommends that large, prospective, RCTs be undertaken to evaluate the efficacy and safety of i.v. iron administration in surgical patients. The implementation of some general good practice points is suggested.
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Multicenter Study
Implementation of outpatient preoperative evaluation clinics: facilitating and limiting factors.
Several studies have shown that outpatient preoperative evaluation by anaesthetists increases quality of care and is cost-effective. The aim of this study was to gain insight into the factors that positively or negatively influence the implementation of outpatient preoperative evaluation clinics (OPE clinics). ⋯ A variety of factors play a role in the implementation of an OPE clinic. Besides the more obvious ones, such as financing and cooperation of the professional groups involved, underlying factors, such as perceptions of the professionals involved, were found to be related to implementation of an OPE clinic. These underlying factors explain differences between different kinds of hospitals and between professional groups, regarding their resources and motivation to implement an OPE clinic.
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Case Reports
Laparoscopic cholecystectomy in a patient with an implantable left ventricular assist device.
Left ventricular assist devices (LVADs) provide mechanical support for left ventricular ejection in the failing heart. We describe the anaesthetic management of a patient with an LVAD requiring laparoscopic cholecystectomy. A 51-yr-old female patient with severe heart disease had a Heartmate II LVAD implanted 4 months before this proposed elective surgery. ⋯ The case was managed successfully using invasive monitoring and anaesthesia with sevoflurane and remifentanil. The potential problems in management of patients with LVADs are highlighted and discussed. A team approach is essential.
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The effects of xenon on regional cerebral blood flow (rCBF) are controversial. Moreover, the precise sites of action at which xenon exerts its effects in the human brain remain to be established. ⋯ Xenon exerted distinct regional effects on CBF: relative decreases in several cortical, subcortical, and cerebellar areas were accompanied by an increase in white matter. Flow-metabolism coupling was not impaired during xenon anaesthesia.