British journal of anaesthesia
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Fluid management during critical illness is a dynamic process that may be conceptualized as occurring in four phases: rescue, optimization, stabilization, and de-escalation (mobilization). The selection and administration of resuscitation fluids is one component of this complex physiological sequence directed at restoring depleted intravascular volume. Presently, the selection of i.v. fluid is usually dictated more by local practice patterns than by evidence. ⋯ There is no evidence to support the use of other colloids. The use of balanced salt solutions in preference to 0.9% saline is supported by the absence of harm in large observational studies. However, there is no compelling randomized trial-based evidence demonstrating improved clinical outcomes with the use of balanced salt solutions compared with 0.9% saline at this time.
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Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, and loss of consciousness occurring around the time of bone cementation. Using a recently proposed severity classification of BCIS, we estimated the incidence of and risk factors for BCIS and its impact on mortality in cemented hemiarthroplasty for femoral neck fractures. ⋯ BCIS is a commonly occurring phenomenon in cemented hemiarthroplasty and severe BCIS has a huge impact on early and late mortality.
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Clinical Trial
Diastolic dysfunction, cardiopulmonary bypass, and atrial fibrillation after coronary artery bypass graft surgery.
Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery, and is associated with increased morbidity, mortality, and utilization of healthcare resources. Diastolic dysfunction (DD) causes a range of changes in left atrial structure and function that may predispose patients to increased risk of AF. We hypothesized that patients with either new or worsened grade of DD after cardiopulmonary bypass (CPB) would have higher prevalence of AF after CABG surgery. The current study sought to determine an association between the dynamic changes in diastolic function during the perioperative period and postoperative AF in patients undergoing CABG surgery. ⋯ http://www.clinicaltrials.gov; unique identifier NCT00188903.
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Randomized Controlled Trial Comparative Study
Comparison of the laryngoscopy views with the size 1 Miller and Macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children <2 yr of age†
Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was designed to compare the laryngeal views with the size 1 Miller and MAC blades in children <2 yr. ⋯ NCT01717872 at Clinical Trials.gov.
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Observational Study
Platelet count and function in paediatric cardiac surgery: a prospective observational study.
Platelet deficiency, impaired platelet function, or both increase the risk of bleeding complications. We assessed platelet count and function during and after paediatric cardiac surgery. Secondary aims included the effect of modified ultrafiltration, identification of factors associated with platelet dysfunction, and to assess associations between platelet function and transfusion requirements. ⋯ Platelet count and platelet aggregation are markedly reduced during and immediately after paediatric cardiac surgery, especially in neonates. The recovery in aggregation is faster than that in platelet count. Intraoperative platelet dysfunction is associated with increased transfusion requirements.