British journal of anaesthesia
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We report four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection who were treated with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure. Three of the four patients had profound shock, necessitating support with venoarterial ECMO. Two patients died during ECMO support. The two survivors had prolonged hospital stays, which were complicated by renal failure and limb ischaemia.
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Early postoperative mobilization is essential for an enhanced recovery, but it can be hindered by orthostatic intolerance, characterized by signs of cerebral hypoperfusion, such as dizziness, nausea, vomiting, and ultimately syncope. Orthostatic intolerance is frequent after major surgical procedures, because of an attenuated cardiovascular response, but the cardiovascular response and the incidence of orthostatic intolerance after minor procedures have not been clarified. We investigated the cardiovascular response and the incidence of orthostatic intolerance during early mobilization after breast cancer surgery. ⋯ With the used regimen of anaesthesia, pain treatment, and fluid therapy, orthostatic intolerance is infrequent 30 min after breast cancer surgery, apparently because the cardiovascular response and tissue oxygenation are preserved. Future studies assessing orthostatic intolerance should focus on larger surgical procedures and apply interventions that potentially maintain the cardiovascular response to mobilization.
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Clinical Trial
Pharmacokinetic profile in relation to anaesthesia characteristics after a 5% micellar microemulsion of propofol in the horse.
To define the pharmacokinetic profile of propofol 5% microemulsion formulation in horses. ⋯ Caution is warranted when propofol is used for continuous infusion due to variable kinetics, myoclonal activity, poor analgesia, and less desirable recovery quality.
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Our aim was to determine whether anaesthetists routinely confirm their ability to ventilate a patient's lungs by a facemask before the administration of a neuromuscular blocker and the rationale for this practice. ⋯ Despite the lack of firm evidence to support the practice of confirming the ability to ventilate the lungs before administering a neuromuscular blocking drug (NMB), we found strongly held views that supported the practice and equally strongly held views that opposed it. However, in a hypothetical emergency situation where ventilation by the facemask after induction of anaesthesia was impossible, the majority of respondents (including 'checkers') would administer a neuromuscular blocker. This apparent paradox can be explained by well-recognized psychological mechanisms. We suggest that in checking the ability to ventilate by the facemask, some anaesthetists are seeking information that may be relevant but not instrumental in deciding when to administer an NMB.