British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Effect of adding dopexamine to intraoperative volume expansion in patients undergoing major elective abdominal surgery.
The contribution of low-dose dopexamine to outcome, when given to increase cardiac output in patients already treated with fluids during major abdominal surgery, is not yet known. ⋯ We could not demonstrate an advantage to using low-dose dopexamine in high-risk patients during major abdominal surgery.
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This study was undertaken to investigate why the superficial cervical plexus block for carotid endarterectomy is so effective. Initial consideration would suggest that a superficial injection would be unlikely to block all terminal fibres of relevant nerves. One possibility is that the local anaesthetic crosses the deep cervical fascia and blocks the cervical nerves at their roots. ⋯ The superficial cervical space communicates with the deep cervical space and this may explain the efficacy of the superficial block. The method of communication remains unknown. Our findings also indicate that the suitable site of injection for the superficial cervical plexus block is below the investing fascia of the neck, and not just subcutaneous.
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Pulse transit time (rPTT), the interval between ventricular electrical activity and arrival of a peripheral pulse waveform, has been used to detect changes in autonomic tone. The aim of this observational pilot study was to measure changes in rPTT in response to general anaesthesia and noxious stimuli. ⋯ Variation in rPTT reflects autonomic responses to nociceptive stimulation and fluctuations in anaesthetic depth independently of heart rate.
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Case Reports
Temporary cardiopulmonary bypass and isolated lung ventilation for tracheal stenosis and reconstruction.
A 27-yr-old lady with a past history of prolonged ventilation presented with worsening respiratory distress caused by tracheal stenosis. She required urgent tracheal resection and reconstruction. ⋯ Thoracotomy was then carried out to mobilize the left main bronchus. After successfully securing an airway by intubation of the left main bronchus, cardiopulmonary bypass was discontinued and tracheal resection and anastomosis was done under conventional one lung anaesthesia.
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Aortic atheromatous disease is known to be associated with an increased risk of perioperative stroke in the setting of cardiac surgery. In this study, we sought to determine the relationship between cerebral microemboli and aortic atheroma burden in patients undergoing cardiac surgery. ⋯ We demonstrate a positive relationship between TCD-detected cerebral emboli and the atheromatous burden of the ascending aorta and aortic arch. Previously demonstrated associations between TCD-detectable cerebral emboli and adverse cerebral outcome may be related to the presence of significant aortic atheromatous disease.