British journal of anaesthesia
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Many physiological functions are altered in the elderly. It is not clear whether this applies to haemostatic mechanisms in patients undergoing major surgery. Twenty-five consecutive patients <60 yr and 25 consecutive patients >70 yr scheduled for abdominal surgery for malignancies were included in our study. ⋯ Platelet function was impaired in the elderly compared with the younger patients. It is concluded that elderly patients showed more prothrombin activation/thrombin generation and increased fibrinolytic activity prior to surgery than younger patients. However, perioperative changes of coagulation in the elderly were similar to those seen in younger patients.
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The bispectral index (BIS) is a complex EEG variable that combines several disparate descriptors of the EEG into a single value. Approximate entropy is a novel EEG measure that quantifies the regularity of a data time series such as EEG. We report two patients in which the EEG effect of propofol was quantified very similarly by BIS and approximate entropy. However, at the beginning of burst suppression of the EEG, BIS did not indicate an increased anaesthetic drug effect, while approximate entropy did.
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Randomized Controlled Trial Comparative Study Clinical Trial
Stress response during weaning after cardiac surgery.
We compared the effects of weaning using synchronized intermittent mandatory ventilation (SIMV) with the use of biphasic positive airway pressure (BIPAP) on the stress response, oxygen uptake (VO2) and work of breathing (WOB) in 10 patients after aortocoronary bypass surgery. All three ventilatory settings were investigated in each patient, for example, volume-controlled mechanical ventilation immediately before weaning was followed, in randomized order, by both SIMV and BIPAP. ⋯ Although respiratory rate (f), WOB and PTP were greater with both SIMV and BIPAP when compared with control, other variables did not change with the ventilatory mode. In conclusion, weaning from mechanical ventilation using partial support modes does not affect the postoperative stress response in patients who have had uncomplicated cardiac surgery.
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Laryngeal views obtained during direct laryngoscopy with and without manual in-line neck stabilization (MILNS) and during video-assisted intubation with MILNS using the angulated video-intubation laryngoscope were assessed in 100 paediatric patients (aged 0.25-17.3 yr). Visualization of the larynx (Cormack and Lehane score) as well as time taken for video-assisted tracheal intubation by six nurses and four resident anaesthetists not experienced in the technique were recorded. ⋯ Video-assisted visualization of the larynx during MILNS produced scores, which were as good or better than those observed during direct laryngoscopy alone. Intubation times ranged from 19-75 s (mean 35 (SD 13.4); median 32).
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Case Reports
Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours.
Patients with metastatic carcinoid tumours often undergo surgical procedures to reduce the tumour burden and associated debilitating symptoms. These procedures and anaesthesia can precipitate a life-threatening carcinoid crisis. To assess perioperative outcomes, we studied retrospectively the medical records of adult patients from 1983 to 1996 who underwent abdominal surgery for metastatic carcinoid tumours. ⋯ Perioperative complications or death occurred in 15 of 119 patients (12.6%, exact confidence interval 7.2-19.9). None of the 45 patients who received octreotide intraoperatively experienced intraoperative complications compared with eight of the 73 patients (11.0%) who did not receive octreotide (P=0.023). The presence of carcinoid heart disease and high urinary output of 5-hydroxyindoleacetic acid preoperatively were statistically significant risk factors for perioperative complications.