British journal of anaesthesia
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Randomized Controlled Trial
Effect of phenylephrine on the haemodynamic state and cerebral oxygen saturation during anaesthesia in the upright position.
The upright sitting or beachchair position is associated with hypotension, risk of cerebral hypoperfusion, and cerebral injury. We hypothesized that by increasing arterial pressure with phenylephrine administration, cerebral perfusion, and postoperative recovery would be improved. ⋯ Despite maintaining arterial pressure with phenylephrine, cerebral desaturation occurred with upright positioning. Cerebral oxygen saturation can provide a valuable endpoint when evaluating the effect of vasopressor therapy on cerebral perfusion.
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Randomized Controlled Trial
Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial.
The inflammatory response to surgical tissue injury is associated with perioperative morbidity and mortality. We tested the primary hypotheses that major perioperative morbidity is reduced by three potential anti-inflammatory interventions: (i) low-dose dexamethasone, (ii) intensive intraoperative glucose control, and (iii) lighter anaesthesia. ⋯ Among our three interventions, dexamethasone alone reduced inflammation. However, no intervention reduced the risk of major morbidity or 1 yr mortality. TRIAL REGISTRATION IDENTIFIER: NCT00433251 at www.clinicaltrials.gov.
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Review
Is thoracic ultrasound a viable alternative to conventional imaging in the critical care setting?
Thoracic imaging is regularly performed on the majority of critical care patients. Conventionally, this uses a combination of plain radiography and computed tomography. There is growing enthusiasm for the use of ultrasound to replace much of this radiology and provide more immediate, point-of-care imaging with reduction in patient transfers, ionizing radiation exposure and cost. ⋯ The technique also has potential to identify the cause of increased EVLW and accurately quantify pleural effusions. More large-scale studies are required in these areas however. Ultrasonography outperforms bedside chest radiography in all cases.
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In this study, we tested the reliability of a non-invasive finger-cuff-based continuous arterial blood pressure monitoring device (Nexfin, BMEYE, Amsterdam, NL) in critically ill surgical patients. ⋯ Non-invasive blood pressure monitoring with Nexfin does not seem to be sufficiently accurate to replace intra-arterial invasive blood pressure measurements in critically ill patients.