British journal of anaesthesia
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Observational Study
Effect of flumazenil on diaphragm electrical activation during weaning from mechanical ventilation after acute respiratory distress syndrome.
Diaphragm electrical activation (EAdi) and the ratio of tidal volume to EAdi (VT/EAdi) may provide clinical information on neuroventilatory efficiency (NVE) in patients being weaned from mechanical ventilation. We tested the hypothesis that residual sedation could interfere with respiratory recovery, by assessing the effects of flumazenil on EAdi and VT/EAdi ratio. ⋯ During weaning from mechanical ventilation, the diaphragmatic contribution to the breathing process may be reduced by residual midazolam-induced ventilatory depression. The increased EAdi with reversal of residual sedation was associated with a proportional increase in VT. These findings should be considered by the attending physician when interpreting daily EAdi and VT changes during weaning from mechanical ventilation.
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The neuropathy of type II diabetes mellitus (DM) is increasing in prevalence worldwide. We aimed to test the hypothesis that in a rodent model of type II DM, neuropathy would lead to increased neurotoxicity and block duration after lidocaine-induced sciatic nerve block when compared with control animals. ⋯ In a rodent type II DM model, nerves have increased sensitivity for short-acting local anaesthetics without adjuvants in vivo, as evidenced by prolonged block duration. This sensitivity appears to increase with the progression of neuropathy. Our results do not support the hypothesis that neuropathy due to type II DM increases the risk of nerve injury after nerve block.
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Devices utilizing near-infrared (NIR) spectroscopy have been used to assess regional intracerebral oxygen saturation (rSO2) during anaesthesia for a decade. The presence of wide differences among individuals reduces their applicability to steady-state measurements. Current devices may not adequately account for variations in skin pigmentation. ⋯ AAs have a lower rSO2 than Caucs as measured by the INVOS 5100C cerebral oximeter. Reasonably, this could be attributed to attenuation of the NIR light by skin pigment. Despite this limitation, in both ethnic groups, lower preoperative rSO2 was predictive of greater operative mortality.