This study compared the efficacy of isoflurane, sevoflurane, and desflurane in achieving hemodynamic stability in spinal procedures using moderate levels of controlled hypotension. After obtaining ethics committee approval and written informed consent, 32 American Surgical Association I-II patients were randomly allocated to receive isoflurane (n=12), sevoflurane (n=10), or desflurane (n=10) in O2-N2O (1:1) for maintenance of anesthesia. The induction of anesthesia, fentanyl dosage, and initial and maintenance volume replacements were standardized. Blood pressure was invasively monitored and maintained within a target systolic blood pressure (SBP) range of 80 to 90 mm Hg during the study. SBP outside this range was recorded. Volatile anesthetic concentration was adjusted according to the same protocol for all 3 agents. SPB control was maintained better with sevoflurane and isoflurane than desflurane; median SBP was outside the target range during 32% (range, 15%-55%) of study time with isoflurane, 26% (12%-42%) with sevoflurane, and 44% (20%-80%) with desflurane. Total blood loss did not differ among the groups. Sevoflurane and isoflurane administered in 2 L/min fresh gas flow were more effective than desflurane in achieving controlled hypotension in spinal surgery.
Innovations in high-speed rail (HSR) have had substantial effects on different stakeholders within and outside the railway system. As part of the European Shift2Rail research programme, several innovative solutions are developed for, among others, improving the HSR infrastructure. The Joint Undertaking behind this research program has set objectives for these innovations in terms of punctuality, capacity, and life cycle costs. With a focus on infrastructure-related innovations for HSR, this paper aims at assessing their impacts in relation to these targets. We review the relevant research literature about the effects of HSR innovations and their assessment. The paper presents a hybrid assessment methodology combing different approaches to assess capacity, punctuality, and cost effects. This contributes to reducing the existing gap that is found in the research literature. Based on a reference scenario for HSR line and collected data from different stakeholders, the results indicate that infrastructure innovations in HSR, being developed within the European Shift2Rail research programme, can contribute to reaching the target set for punctuality. Further innovations in HSR infrastructure and/or other railway assets may be needed to reach additional targets and for more accurate improvement values giving more insights into their impacts.
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