British journal of anaesthesia
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Randomized Controlled Trial
Circulating-water garment or the combination of a circulating-water mattress and forced-air cover to maintain core temperature during major upper-abdominal surgery.
A recent heat-balance study in volunteers suggested that greater efficacy of circulating-water garments (CWGs) results largely from increased heat transfer across the posterior skin surface since heat transfer across the anterior skin surface was similar with circulating-water and forced-air. We thus tested the hypothesis that the combination of a circulating-water mattress (CWM) and forced-air warming prevents core temperature reduction during major abdominal surgery no worse than a CWG does. ⋯ The combination of a CWM and forced-air warming is significantly non-inferior in maintaining intraoperative core temperature than a CWG.
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Continuous non-invasive measurement of finger arterial pressure (FAP) is a reliable technology in adults. FAP is measured with an inflatable cuff around the finger and simultaneously converted to a reconstructed brachial artery pressure waveform (reBAP) by the Nexfin™ device. We assessed the adequacy of a prototype device (Nexfin-paediatric), designed for a paediatric population, for detecting rapid arterial pressure changes in children during cardiac surgery. ⋯ The prototype device closely follows arterial pressure changes in children. However, in a considerable number of attempts, obtaining a signal was time-consuming or unsuccessful. This technique seems promising but requires further technical development.
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It is controversial as to whether T-wave elevation is caused by local anaesthetics, epinephrine, or their combination. It has been shown that T-elevation after intravascular injection of a small bupivacaine test dose is caused by epinephrine and not by bupivacaine. The aim of this study was to investigate ECG changes with higher doses of i.v. bupivacaine. ⋯ Higher doses of i.v. infused bupivacaine can cause T-elevation. With slower injection technique, T-elevation can already be detected at lower bupivacaine doses administered.
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Plasma-free volume replacement in haemorrhage often results in dilutional coagulopathy. Prothrombin time index (PTI) and activated partial thromboplastin time (aPTT) are used for monitoring haemostasis but have not yet been clinically evaluated. Our aim was to investigate the effects of haemodilution on the course of global coagulation tests and clotting factors (CFs). ⋯ PTI and MCF are useful for monitoring dilution and intervention points. aPTT and CT reflect intervention points when showing pathological values. The type of diluents does not seem to interfere with PTI and aPTT, but HAES impairs haemostasis in ROTEM(®) more profoundly than saline.
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Comparative Study
Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study.
This study compared the fluid leakage in the new 'tapered' shaped against the classic 'cylindrical' shaped tracheal tube cuffs when placed in different sized tracheas. ⋯ The tapered PU tube cuff was as effective as the cylindrical PU cuffs in smaller tracheal diameters and was more efficient than the cylindrical Microcuff PU tube cuff in larger tracheal diameter in preventing subglottic fluid leakage across the tube cuff tested in this in vitro study. PVC tube cuffs leaked much more and faster than PU cuffs.