British journal of anaesthesia
-
Randomized Controlled Trial
Influence of systolic-pressure-variation-guided intraoperative fluid management on organ function and oxygen transport.
Dynamic variables, for example, systolic pressure variation (SPV), are superior to filling pressures for assessing fluid responsiveness. We analysed the effects of SPV-guided intraoperative fluid management on organ function and perfusion when compared with routine care. ⋯ In comparison with routine care, intraoperative SPV-guided treatment was associated with slightly increased fluid adminstration whereas organ perfusion and function was similar.
-
In this study we analyse the behaviour, potential clinical application and optimal cortical sampling location of the spectral parameters: (i) relative alpha and beta power; (ii) spectral edge frequency 90%; and (iii) spectral entropy as monitors of moderate propofol-induced sedation. ⋯ Relative beta power and spectral entropy when considered over the propofol effect-site range studied here increase in value, and correlate well with clinical assessment of sedation.
-
Respiratory variations in pulse oximetry plethysmographic waveform amplitude (DeltaPOP) can predict fluid responsiveness in mechanically ventilated patients but cannot be easily assessed at the bedside. Pleth variability index (PVI) is a new algorithm allowing for automated and continuous monitoring of DeltaPOP. We hypothesized that PVI can predict fluid responsiveness in mechanically ventilated patients under general anaesthesia. ⋯ PVI, an automatic and continuous monitor of DeltaPOP, can predict fluid responsiveness non-invasively in mechanically ventilated patients during general anaesthesia. This index has potential clinical applications.
-
The metabolism of the short-acting anaesthetic agent propofol has been described over the first 24 h. However, the long-term disposition of propofol and its metabolites is unclear. We describe the pharmacokinetics (renal excretion rates and renal clearance) of propofol and its metabolites over 60 h. ⋯ After an infusion of propofol, patients excrete propofol and its metabolites in the urine over a period in excess of 60 h. We hypothesize that (re)absorption of propofol and its metabolites by the kidney is a major process in elimination and that the reabsorbed compounds are gradually conjugated in the kidney and excreted in the urine. One patient showed a different pharmacokinetic profile for which we currently have no explanation.
-
As a result of its very low water solubility, propofol is generally presented as a lipid-based formulation with well-characterized limitations. ⋯ Propofol-PM formulations produce anaesthesia in rats. Whole blood pharmacokinetics of Propofol-PM did not differ from those observed with Diprivan.