British journal of anaesthesia
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Comparative Study Retracted Publication
Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery.
Thermodilution technique using a pulmonary artery catheter (PAC) is a widely used method to determine cardiac output (CO). It is increasingly criticized because of its invasiveness and its unclear risk-benefit ratio. Thus, less invasive techniques for measuring CO are highly desirable. We compared a new, semi-invasive device (FloTrac/Vigileo) using arterial pressure waveform analysis for CO measurement in patients undergoing cardiac surgery with bolus thermodilution measurements. ⋯ In cardiac surgery patients, CO measured by a new semi-invasive arterial pressure waveform analysis device showed only moderate agreement with intermittent pulmonary artery thermodilution measurement.
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Influence of different volume therapy regimens on regulators of the circulation in the critically ill.
Various vasoactive substances are involved in the regulation of the macro- and microcirculation. We have investigated if these regulators change during long-term volume therapy with human albumin (HA) or hydroxyethylstarch solution (HES) in trauma and sepsis patients. To maintain pulmonary capillary wedge pressure (PCWP) at 10-15 mm Hg, either 20% HA (HA-trauma, n = 14; HA-sepsis, n = 14) or 10% low-molecular weight HES solution (HES-trauma, n = 14; HES-sepsis, n = 14) were infused for 5 days, otherwise patient management did not differ between the two groups (trauma/sepsis). ⋯ In both sepsis groups, vasopressors (vasopressin, endothelin-1, noradrenaline and adrenaline) were significantly increased above normal at baseline and decreased more markedly in HES than in HA patients. Concentrations of atrial natriuretic peptide increased only in the HA patients (from 159 (SD 31) to 215 (38) pg ml-1 on day 2). Plasma concentrations of 6-keto-prostaglandin F1 alpha decreased significantly only in the HES sepsis patients (from 112 (25) to 47 (15) pg ml-1).
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Randomized Controlled Trial Clinical Trial Retracted Publication
Does the type of volume therapy influence endothelial-related coagulation in the critically ill?
The endothelium plays an important role in the regulation of haemostasis by producing substances such as thrombomodulin (TM). The influence of long-term volume replacement with different types of fluid on the TM-protein C-protein S system was investigated in a prospective, randomized study. Thirty trauma patients and 30 patients suffering from sepsis after major surgery received either 10% low-molecular weight (LMW) hydroxyethylstarch solution (HES-trauma, n = 15; HES-sepsis, n = 15) or 20% human albumin (HA-trauma, n = 15; HA-sepsis, n = 15) for 5 days to maintain central venous pressure (CVP) between 12 and 16 mm Hg. ⋯ TAT (indicating intravascular coagulation) did not differ between the two fluid groups. We conclude that in trauma patients, the type of volume therapy had no influence on the TM-protein C-protein S system. In sepsis patients, volume therapy with HES was beneficial, whereas infusion of HA had no substantial positive effect on endothelial-associated coagulation.
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Post-tetanic count and single twitch height at the onset of reflex movement after administration of vecuronium under different types of anaesthesia.
We have studied post-tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecuronium with five different types of anaesthesia. Seventy-five adult patients were allocated randomly to five groups of 15 patients each, to receive one of the following anaesthetics: neuroleptanaesthesia (fentanyl and droperidol) or 1 MAC of either halothane, isoflurane, enflurane or sevoflurane with 66% nitrous oxide in oxygen. ⋯ Single twitch heights at the onset of reflex movement were similar (2.0-2.7% of control values) between the five groups. In contrast, PTC at the onset of reflex movement to carinal stimulation differed (7.4-17.0) between groups.
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Comparative Study Retracted Publication
Relationship between post-tetanic twitch and single twitch response after administration of vecuronium.
We have studied the relationship between post-tetanic twitch (PTT) and single twitch response after administration of vecuronium 0.2 mg kg-1 in 100 patients during neuroleptanaesthesia (NLA) (droperidol and fentanyl) and during anaesthesia with halothane, isoflurane, enflurane or sevoflurane (1 MAC in nitrous oxide and oxygen). Intervals from PTT1 to single twitch, and post-tetanic-count (PTC) (number of PTT responses) at the onset of single twitch were determined electromyographically. ⋯ PTC in the isoflurane, enflurane and sevoflurane groups differed from those in the NLA group, and PTC in the sevoflurane group significantly from those in the NLA and halothane groups. These results are consistent with the view that PTT reflects prejunctional block, whilst the single twitch response is indicative of postjunctional block.