British journal of anaesthesia
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The acute hypoxic ventilatory response is a critical chemoreflex originating at the carotid bodies. This study investigates the impact of low-dose i.v. esketamine on the ventilatory response to 20 min of isocapnic hypoxia to test the hypothesis that esketamine does not affect hypoxic ventilation. ⋯ The trial was registered at the ISRCTN registry on June 27, 2023 under identifier ISRCTN 42617929 (https://www.isrctn.com/ISRCTN42617929).
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Editorial Review
Improving lung protective mechanical ventilation: the individualised intraoperative open-lung approach.
Despite the maturity and sophistication of anaesthesia workstations, improvements in our understanding of intraoperative mechanical ventilation, and use of less invasive surgical techniques, postoperative pulmonary complications (PPCs) are still a common problem in surgical patients of all ages. PPCs are associated with a higher incidence of perioperative morbidity and mortality, longer hospital stays, and higher healthcare costs. PPCs are strongly associated with anaesthesia-induced atelectasis, which predisposes to lung damage when partially collapsed lungs are subjected to mechanical ventilation. ⋯ Intraoperative protective ventilation strategies have been based on two main but intrinsically different hypotheses: one based on sole reduction of tidal volume and pressures, using minimal positive end-expiratory pressure (PEEP), tolerating the presence of lung collapse, and the other also limiting tidal volume and pressures after actively resolving atelectasis by lung recruitment and PEEP individualisation, the individualised open-lung approach. We review the concepts of the individualised open-lung approach, its potential benefits, and outstanding questions. We conclude with a proposal for personalised lung protective ventilation.
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The incidence of severe adverse events in children with SARS-CoV-2 undergoing anaesthesia has not been well established. We examined the relationship between SARS-CoV-2 infection and severe perioperative adverse events in children. ⋯ In the largest cohort to date of paediatric patients undergoing general anaesthesia, SARS-CoV-2 infection was associated with severe perioperative adverse events, but no children in the infected cohort died.
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Comparative Study Observational Study
Comparison of ROTEM® Delta and ROTEM® Sigma transfusion algorithm performance in thoracic aortic surgery: a single-centre prospective observational cohort study.
Thromboelastometry plays a key role in many transfusion algorithms. ROTEM® Sigma is the fully automated successor of ROTEM® Delta. Compatibility with current ROTEM® Delta-based algorithms remains uncertain. This study compares ROTEM® Delta with ROTEM® Sigma in patients undergoing thoracic aortic surgery. ⋯ Netherlands trial register NL8273.
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Systemic inflammation after heart valve replacement surgery commonly results in complications including cognitive impairment. This study was designed to investigate whether valvular heart disease itself and inflammation after valve replacement surgery affects cognition and the related functional connectivity (FC) of the hippocampal memory network. ⋯ ChiCTR2300069614.