British journal of anaesthesia
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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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Postoperative throat complications, such as sore throat and hoarseness, are frequent complications of tracheal intubation. To assess whether severity of throat complications is related to the experience of physicians performing tracheal intubation, we compared the incidence and duration of postoperative sore throat and hoarseness and patient satisfaction between tracheal intubation performed by trainees and experienced consultant anaesthetists. ⋯ Tracheal intubation by trainees under the supervision of consultant anaesthetists did not worsen the postoperative airway outcomes, such as sore throat and hoarseness.
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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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Comparative Study
Five algorithms that calculate cardiac output from the arterial waveform: a comparison with Doppler ultrasound.
Different mathematical approaches are used to calculate arterial pulse pressure wave analysis (PPWA) cardiac output. The CardioQ-Combi is a research oesophageal Doppler (COODM) monitor that includes these five fundamental PPWA algorithms. We compared these PPWA cardiac output readings to COODM and suprasternal USCOM Doppler (COUS) over a range of cardiac output values induced by dopamine infusion in patients undergoing major surgery. USCOM acted as a control. ⋯ The Liljestrand-Zander PPWA formula was most reliable compared with oesophageal Doppler in major surgical patients under general anaesthesia, but not better than USCOM.
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Bioreactance is a novel noninvasive method for cardiac output measurement that involves analysis of blood flow-dependent changes in phase shifts of electrical currents applied across the thorax. The present study evaluated the test-retest reliability of bioreactance for assessing haemodynamic variables at rest and during exercise. ⋯ The bioreactance method demonstrates good test-retest reliability for estimating cardiac output at rest and during different stages of graded exercise testing including maximal exertion.