Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial.

Background: Off-pump coronary artery bypass (OPCAB) surgery carries a high risk for haemodynamic instability and perioperative organ injury. Favourable haemodynamic effects and organ-protective properties could render xenon an attractive anaesthetic for OPCAB surgery. The primary aim of this study was to assess whether xenon anaesthesia for OPCAB surgery is non-inferior to sevoflurane anaesthesia with regard to intraoperative vasopressor requirements.

Alizapride and ondansetron for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic gynaecological surgery: A double-blind, randomised, placebo-controlled noninferiority study.

Background: Postoperative nausea and vomiting (PONV) can be prevented. Alizapride is an established antiemetic that may be effective in this role.

Objective: Our primary objective was to test the hypothesis that alizapride is noninferior to ondansetron for the prophylaxis of PONV.

A safety and efficacy evaluation of hemoglobin-based oxygen carrier HBOC-201 in a randomized, multicenter red blood cell controlled trial in noncardiac surgery patients.

Background: We present the results of a previously unpublished hemoglobin-based oxygen carrier (HBOC) study conducted in 1998-1999.

Methods: In a multicenter, randomized, single-blind, comparative study of HBOC-201 versus allogeneic red blood cell (RBC) transfusions, no-cardiac surgery patients received HBOC-201 to a maximum of 7 units (n = 83) or RBCs (n = 77). Patients could be switched to RBCs for safety or any other reason.

Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes.

Objective: Prolonged aortic crossclamping can increase mortality and morbidity after aortic valve replacement in elderly and high-risk patients. Sutureless implantation of the prosthesis has the potential to shorten aortic crossclamp time.

Methods: The Perceval S valve (Sorin Biomedica Cardio Srl, Sallugia, Italy), a sutureless implantable aortic bioprosthesis, was used in 32 patients (median age, 78 years; median logistic euroSCORE, 9.

Aprotinin reduces cardiac troponin I release and inhibits apoptosis of polymorphonuclear cells during off-pump coronary artery bypass surgery.

Objectives: In addition to blood-sparing effects, aprotinin may have cardioprotective and anti-inflammatory effects during cardiopulmonary bypass-assisted cardiac surgery. In this study, the authors examined whether aprotinin had cardioprotective and/or anti-inflammatory effects in patients undergoing off-pump coronary artery bypass grafting.

Design: A prospective randomized clinical trial.

Performance analysis of interactive multimodal CME retraining on attitude toward and application of OPCAB.

Objective: The transfer of tacit and codified knowledge on a surgical technique is studied in a consecutive cohort of teams participating in interactive multimodal continuing medical education (CME) retraining in off-pump coronary artery bypass (OPCAB).

Methods: Fifty teams of 1.3 +/- 0.

Cardiac output monitoring using a brachial arterial catheter during off-pump coronary artery bypass grafting.

Objective: To investigate the accuracy of cardiac output measurements by transpulmonary thermodilution and pulse contour analysis using a brachial arterial catheter.

Study Design: Criterion standard study.

Setting: University hospital, single institution.

Evaluation of the neuroprotective effects of S(+)-ketamine during open-heart surgery.

Unlabelled: We compared the effect of S(+)-ketamine to remifentanil, both in combination with propofol, on the neurocognitive outcome after open-heart surgery in 106 patients. A battery of neurocognitive tests was administered before surgery and 1 and 10 wk after surgery. Fourteen patients (25%) in the control group and 10 patients (20%) in the S(+)-ketamine group had 2 or more tests with a cognitive deficit (decline by at least one preoperative SD of that test in all patients) 10 wk after surgery (P = 0.

OPCAB versus early mortality and morbidity: an issue between clinical relevance and statistical significance.

Objective: To evaluate the impact of OPCAB on major postoperative events in a large consecutive cohort of patients, covering the complete spectrum of risk.

Methods: A consecutive series of 3333 CABG patients operated in a single institution (Jan/97-Jan/03) is analyzed after a complete (98%) midterm reengineering towards off-pump surgery (Oct/99). Patients in cardiogenic shock are excluded.

Training needs and qualifications of anaesthesiologists not exposed to ALS.

Objectives: To establish which needs exist for specific training in Advanced Cardiac Life Support (ALS) in anaesthesiology residents and interns not exposed to structured ALS courses.

Methods: 48 residents, and seven interns accepted for training in anaesthesiology, were tested in a spontaneous, blind, cross-sectional, prospective assessment using a recording manikin with validated scoring system, a questionnaire, and 35 multiple-choice questions.

Results: 65% admitted not having had any CPR training within the last 2 years.

Is transcranial Doppler useful in the detection of internal carotid artery cross-clamp intolerance?

The aim of this study was to test the hypothesis that a drop in the systolic blood flow velocity in the middle cerebral artery of 70% or more, measured by transcranial Doppler, is a better criteria in the detection of cross-clamp intolerance than electroencephalogram (EEG) and somatosensory evoked potential (SSEP) monitoring. After exclusion of patients with a recent stroke, urgent procedures and combined procedures, a transcranial Doppler with compression test was scheduled in 85 patients. In 13 patients the drop was 70% or more and in these patients a transcranial Doppler was also performed during the reconstruction of the internal carotid artery (the study group) under general anaesthesia.

The value of carotid stump pressure and EEG monitoring in predicting carotid cross-clamping intolerance.

The authors analyse their experience with carotid stump pressure (CSP) and electro-encephalogram (EEG) monitoring in relation to the incidence of peroperative stroke during internal carotid artery reconstruction. A series of 215 patients is presented, among whom six (2.8%) developed a peroperative stroke.

Propofol anesthesia does not inhibit stimulation of cortisol synthesis.

Recent data suggest a negative effect of propofol anesthesia on cortisol secretion. The present study was designed to evaluate the effect of propofol anesthesia on the steroidogenic potential of the adrenal glands. The response of cortisol secretion to stimulation with an adrenocorticotropic hormone (ACTH) analog during intravenous anesthesia with propofol has not been reported before.

[Anesthetics: total intravenous anesthesia or inhalation anesthesia in neurosurgery].

In this review article the pro's and contra's of the use of either inhalational or intravenous anaesthetics for neurosurgical procedures are discussed. The objective is to stimulate thoughts concerning controversial subjects, rather than to resolve issues. It is much less complicated to approach the practice of neuroanaesthesia with a few straight forward "rules" based on laboratory measurements (such as intravenous drugs are good because they reduce CBF and ICP, whereas inhalational agents are bad because they increase CBF and ICP).

Carotid artery surgery in the presence of an occlusion of the contralateral carotid artery: perioperative risk analysis and follow-up.

A retrospective study of 129 carotid artery reconstructions with an occlusion of the contralateral internal carotid artery (group CO) is presented. A control group comprised 489 patients with a stenosis of < 50% at the contralateral side (group CN). Both groups had the same mean age.

A comparison of the 2% and 1% formulations of propofol during anaesthesia for craniotomy.

This study investigated the pharmacodynamic and pharmacokinetic equivalence of 1% and 2% propofol emulsions when used for total intravenous anaesthesia for intracranial surgery. The same infusion rate (6.7 mg.

Relative potency of eltanolone, propofol, and thiopental for induction of anesthesia.

Background: The primary purpose of this investigation was to determine the relative potency of eltanolone, a new steroid hypnotic, and propofol and thiopental when used for induction of general anesthesia. In addition, the induction characteristics of propofol and eltanolone were compared.

Methods: One hundred seventy-five patients, premedicated with lorazepam 1 mg orally, randomly received one of six different doses of either eltanolone or propofol.

Embolization of arteriovenous malformations of the brain: preliminary experience.

Transcatheter embolization was performed in 8 young patients (mean age 24.5 years) with intracerebral arteriovenous malformations. In total 12 arteries were embolized in 10 sessions.

Vital organ blood flow during deliberate hypotension in dogs.

Increasing the inspiratory concentration of isoflurane is a commonly used technique for producing deliberate hypotension (DH) when isoflurane is used as the principal anesthetic. When an intravenous anesthetic technique is used, DH can be produced by the administration of a peripheral vasodilator, eventually in association with low concentrations of isoflurane. The aim of this investigation was to compare the effects of these two different approaches on vital organ blood flow.

Blood pressure management during aortic surgery: urapidil compared to isosorbide dinitrate.

The efficacy and hemodynamic effects of urapidil, an arteriolar vasodilator, and isosorbide dinitrate, a venodilator, were compared, when used for blood pressure control during abdominal aortic surgery. Urapidil is an alpha-adrenergic receptor antagonist with serotonin-1A receptor-agonist activity in the central nervous system. Hemodynamic profiles were recorded before and after the administration of the study drug (+/- 10 minutes before aortic clamping), 3 and 10 minutes following aortic clamping, and before and 3 and 10 minutes following the removal of the aortic clamp.

Light anaesthesia with propofol for paediatric MRI.

Anaesthetic techniques and monitoring equipment may interfere with the technical demands of magnetic resonance imaging. The purpose of this study was to evaluate the safety and efficacy of a light anaesthetic technique with intravenous propofol in nonintubated children. In 20 neuropaediatric patients sedation was induced with propofol 1 mg.

Influence of hydroxyethyl starch on coagulation in patients during the perioperative period.

The perioperative use of hydroxyethyl starch (HES) has been implicated as a possible cause of intracranial bleeding. The purpose of this study was to compare the influence on blood coagulation of the isovolemic replacement of 1-L blood loss with either 6% HES (molecular weight [MW] average: 450,000) or 5% human albumin during neurosurgery or lower abdominal surgery. Twenty patients scheduled for brain tumor surgery and 20 patients undergoing transabdominal hysterectomy were studied.

EEG-assisted titration of propofol infusion during neuroanesthesia: effect of nitrous oxide.

Total intravenous anesthesia (TIVA) with propofol is an alternative to standard techniques for neuroanesthesia. The present study compared the hemodynamic and recovery profiles of 46 neurosurgical patients randomly assigned to one of three different anesthetic treatment groups. Group 1 was anesthetized with a TIVA technique in which propofol was titrated using an EEG-assisted quantification method.