British journal of anaesthesia
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This narrative review evaluates the evidence regarding the protection offered by isolation gowns, approaches to imparting antimicrobial activity to gowns, and the environmental impacts of gown use, particularly during the COVID-19 pandemic. We conducted a search of the Medline, PubMed, and Google Scholar databases for articles published between January 1, 2019 to February 20, 2024. We found that current standards pertaining to isolation gowns might be irrelevant to the protection of healthcare workers from pathogen transmission, as they focus primarily on fluid barrier resistance values that are not reflective of all transmission conditions in hospitals. ⋯ However, evidence of the effectiveness of such techniques in clinical settings is scarce. We advocate for standardised guidelines inclusive of common pathogen survival tests, comfort, and durability, which reflect the actual infection risks encountered by healthcare workers, to improve the safety and efficacy of isolation gowns in hospital settings. Further research into the clinical effectiveness of antimicrobial gowns and their long-term implications on the environment is also warranted.
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Editorial Review
Neuroanatomical and pharmaco-physiological effects of hypoxia and esketamine on breathing, the sympathetic nerve system, and cortical function.
Acute hypoxic ventilatory response is an important reflex that helps maintain breathing during low oxygen levels, but it is attenuated by most general anaesthetics. Analgesic doses of ketamine and esketamine are known to have respiratory stimulant effects. ⋯ Participants also exhibited higher levels of alertness and unpleasant psychotropic effects compared with the control condition. We review the pharmaco-physiological effects of acute hypoxia and its interactions with esketamine. We provide a summary of the effects of hypoxia and esketamine on the neurocircuitry that leads to arousal, activation of the sympathetic nerve system, and increased drive to upper airway dilator and respiratory pump muscles.
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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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Multicenter Study
Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies.
Optimised use of kidney function information might improve cardiac risk prediction in noncardiac surgery. ⋯ ClinicalTrials.gov NCT00512109 (VISION) and NCT01082874 (POISE-2).
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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.