British journal of anaesthesia
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Dynamic indices, including pulse pressure, systolic pressure, and stroke volume variation (PPV, SPV, and SVV), are accurate predictors of fluid responsiveness under strict conditions, for example, controlled mechanical ventilation using conventional tidal volumes (TVs) in the absence of cardiac arrhythmias. However, in routine clinical practice, these prerequisites are not always met. We evaluated the effect of regularly used ventilator settings, different calculation methods, and the presence of cardiac arrhythmias on the ability of dynamic indices to predict fluid responsiveness in sedated, mechanically ventilated patients. ⋯ PPV, SPV, and SVV are the only reliable predictors of fluid responsiveness under strict conditions. In routine clinical practice, factors including low TV, cardiac arrhythmias, and the calculation method can substantially reduce their predictive value.
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Clinical Trial
Population pharmacokinetics of dexmedetomidine during long-term sedation in intensive care patients.
Dexmedetomidine is a highly selective and potent α(2)-adrenoceptor agonist registered for sedation of patients in intensive care units. There is little information on factors possibly affecting its pharmacokinetics during long drug infusions in critically ill patients. We characterized the pharmacokinetics of dexmedetomidine in critically ill patients during long-term sedation using a population pharmacokinetic approach. ⋯ The population pharmacokinetics of dexmedetomidine was generally in line with results from previous studies. In elderly patients and in patients with hypoalbuminaemia, the elimination half-life and the context-sensitive half-time of dexmedetomidine were prolonged.
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Early postoperative mobilization is a cornerstone in fast-track total hip arthroplasty (THA), but postoperative orthostatic intolerance (OI) may delay early recovery or lead to fainting, falls, and prosthesis dislocation or fracture. However, the prevalence and pathophysiology of OI has not been established after THA. This study evaluated the cardiovascular response and tissue oxygenation to mobilization before and after surgery in relation to OI in fast-track THA patients. ⋯ Early postoperative OI is common in patients undergoing THA and is associated with an impaired cardiovascular orthostatic response and decreased cerebral oxygenation.
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An analysis of perioperative factors that were independently associated with survival up to 1000 days after scheduled colorectal adenocarcinoma resections in 314 patients. ⋯ Immediate perioperative care may have prolonged effects on postoperative survival. Specialized preoperative assessment clinics may reduce mortality after colorectal surgery.
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Postoperative nausea and vomiting (PONV) is common but many episodes may be trivial or transient. The aim of the study was to develop a simple-to-use measure of the intensity and clinical impact of PONV. ⋯ We have devised and validated a simplified PONV impact scale that can be used to identify those with clinically important PONV. The avoidance of clinically important PONV could be used as a quality indicator or outcome measure after surgery.