British journal of anaesthesia
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Randomized Controlled Trial
Effect of the carrier solution for hydroxyethyl starch on platelet aggregation and clot formation.
Hydroxyethyl starch (HES) solutions alter blood coagulation, mainly platelet function and fibrinogen polymerization. Haemostasis can also be impaired by dilutional-hyperchloraemic acidosis induced by the HES carrier solution. We hypothesized that a saline-based tetrastarch carrier solution impairs parameters of blood coagulation more than a balanced carrier solution. ⋯ The carrier solution for HES up to 20 ml kg(-1) had little impact on platelet aggregation or clot formation as assessed by MEA and rotational thrombelastometry, respectively. Further clinical studies are required to verify this finding in patients and to correlate results of whole blood aggregometry and rotational thrombelastometry with perioperative bleeding and transfusion requirements.
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Low tidal volume (V(T)), PEEP, and low plateau pressure (P(PLAT)) are lung protective during acute respiratory distress syndrome (ARDS). This study tested the hypothesis that the aspiration of dead space (ASPIDS) together with computer simulation can help maintain gas exchange at these settings, thus promoting protection of the lungs. ⋯ The protective ventilation strategy of adequate pH or PaCO2 with minimal V(T), and high/safe P(PLAT) resulting in high PEEP was based on the avoidance of known lung-damaging phenomena. The approach is based upon the optimization of V(T), RR, PEEP, I/E, and dead space. This study does not lend itself to conclusions about the independent role of each of these features. However, dead space reduction is fundamental for achieving minimal V(T) at high RR. Classical physiology is applicable at high RR. Computer simulation optimizes ventilation and limiting of dead space using ASPIDS. Inspiratory P(el)/V curves recorded from PEEP or, even better, expiratory P(el)/V curves allow monitoring in ARDS.
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Randomized Controlled Trial
Remifentanil during cardiac surgery is associated with chronic thoracic pain 1 yr after sternotomy.
Chronic thoracic pain after cardiac surgery is a serious condition affecting many patients. The aim of this study was to identify predictors for chronic thoracic pain after sternotomy in cardiac surgery patients by analysing patient and perioperative characteristics. ⋯ In this follow-up study in cardiac surgery patients, intraoperative remifentanil was predictive for chronic thoracic pain in a dose-dependent manner. Randomized studies designed to evaluate the influence of intraoperative remifentanil on chronic thoracic pain are needed to confirm these results.
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Randomized Controlled Trial Comparative Study
Lung isolation in the morbidly obese patient: a comparison of a left-sided double-lumen tracheal tube with the Arndt® wire-guided blocker.
Obese patients are at risk of complications during airway management including difficult tracheal intubation. There are no reports regarding the ease of intubation or efficiency of lung collapse with the use of lung isolation devices for the morbidly obese patient. We conducted a prospective, randomized study in morbidly obese patients undergoing one-lung ventilation. We compared the effectiveness and ease of placement of a left-sided double-lumen tube and the Arndt(®) blocker. ⋯ There is no overall advantage of one device over the other during intubation of the morbidly obese patient.
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Available alfentanil pharmacokinetic (PK) sets for target-controlled infusion (TCI) were derived from populations with normal BMI. The performance and accuracy of the models devised by Maitre and colleagues and Scott and colleagues were evaluated in a population including morbidly obese patients. ⋯ Maitre and colleagues' PK set underestimated the predicted concentrations in our mixed-weighted population, but its bias and accuracy were acceptable for clinical application. Scott and colleagues' model was inaccurate. The NONMEM model seemed to be more accurate during the infusion and for high concentrations, but it needs to be validated in a larger population.