British journal of anaesthesia
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We reviewed our experience with tracheal extubation in the operating room (E-OR) among cystic fibrosis patients requiring bilateral lung transplantation to evaluate safety and determine predictive factors of E-OR. ⋯ Our protocol allowed for extubation of 46% of bilateral lung transplant patients without increased postoperative risks.
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Observational Study
Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery.
General anaesthesia decreases pulmonary compliance and increases pulmonary shunt due to the development of atelectasis. The presence of capnoperitoneum during laparoscopic surgery may further decrease functional residual capacity, promoting an increased amount of atelectasis compared with laparotomy. The aim of this study was to evaluate the effects of different levels of positive end-expiratory pressure (PEEP) in both types of surgery and to investigate whether higher levels of PEEP should be used during laparoscopic surgery. ⋯ Both surgeries have similar negative effects on pulmonary shunt, while the presence of capnoperitoneum reduced only the pulmonary compliance. It appears that a more aggressive PEEP level is required to reduce shunt and to maximize compliance in case of laparoscopic surgery.
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We carried out a retrospective assessment of whether perioperative fluid volume was associated with length of hospital stay (LOS) after colorectal surgery. ⋯ Greater perioperative fluid volume was independently associated with prolonged duration of recovery across a spectrum of surgical risk profiles. Fluid restriction should be considered a part of the care package in enhanced recovery after surgery programmes for colorectal surgery.
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Although arterial hypotension occurs frequently with propofol use in humans, its effects on intravascular volume and vascular capacitance are uncertain. We hypothesized that propofol decreases vascular capacitance and therefore decreases stressed volume. ⋯ Netherlands Trial Register: NTR2486.
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Homogeneous ventilation is important for prevention of ventilator-induced lung injury. Electrical impedance tomography (EIT) has been used to identify optimal PEEP by detection of homogenous ventilation in non-dependent and dependent lung regions. We aimed to compare the ability of volumetric capnography and EIT in detecting homogenous ventilation between these lung regions. ⋯ In postoperative cardiac patients, calculated dead space agreed well with EIT to detect the optimal PEEP for an equal distribution of inspired volume, amongst non-dependent and dependent lung regions. Airway dead space reduces at decreasing PEEP levels.