British journal of anaesthesia
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Review Meta Analysis
Aspirin and coronary artery surgery: a systematic review and meta-analysis.
Aspirin administration before cardiac surgery represents a balance between preventing perioperative thrombotic events and promoting surgical bleeding. Clear evidence to guide the preoperative use of aspirin in patients undergoing cardiac surgery is lacking.This systematic review and meta-analysis was performed to evaluate the efficacy and safety of preoperative aspirin, in patients undergoing coronary artery surgery. ⋯ In patients undergoing coronary artery surgery, preoperative aspirin reduces perioperative MI, but at a cost of increased bleeding, blood transfusion, and surgical re-exploration.
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Cardiovascular resuscitation is a cornerstone of critical care practice. Experimental advances have increased our understanding of the role of the microcirculation in shock states and the development of multi-organ failure. Strategies that target the microcirculation in such conditions, while theoretically appealing, have not yet been shown to impact upon clinical outcomes. This review outlines the current understanding of microcirculatory dysfunction in septic, cardiogenic, and hypovolaemic shock and outlines available treatments and strategies with reference to their effects upon the microcirculation.
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Randomized Controlled Trial Observational Study
Intraoperative hypotension and delirium after on-pump cardiac surgery†.
Delirium is a common complication after cardiac surgery and may be as a result of inadequate cerebral perfusion. We studied delirium after cardiac surgery in relation to intraoperative hypotension (IOH). ⋯ Independent of the applied definition, IOH was not associated with the occurrence of delirium after cardiac surgery.
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Observational Study
Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery†
Postoperative delirium is common in older patients. Despite its prognostic significance, the pathophysiology is incompletely understood. Although many risk factors have been identified, no reversible factors, particularly ones potentially modifiable by anaesthetic management, have been identified. The goal of this prospective cohort study was to investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing major non-cardiac surgery. ⋯ These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium.
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Observational Study
Decrease in pulse pressure and stroke volume variations after mini-fluid challenge accurately predicts fluid responsiveness.
Dynamic indices, such as pulse pressure variation (PPV), are inaccurate predictors of fluid responsiveness in mechanically ventilated patients with low tidal volume. This study aimed to test whether changes in continuous cardiac index (CCI), PPV, and stroke volume variation (SVV) after a mini-fluid challenge (100 ml of fluid during 1 min) could predict fluid responsiveness in these patients. ⋯ The ΔSVV100 and ΔPPV100 predict fluid responsiveness accurately and better than ΔCCI100 (PiCCO™; Pulsion) in patients with circulatory failure and ventilated with low volumes.