It is possible to implant a well-functioning sutureless stent-mounted valve in the aortic position in less than 20 minutes of aortic crossclamping. This is associated with excellent early clinical and hemodynamic outcome in high-risk patients. Moderate changes in hematologic parameters persisted but were not related to clinical events.
The purpose of this study was to investigate the effect of propofol on cerebral blood flow, cerebral metabolism, and cerebrovascular autoregulatory capability. Seven anesthetized baboons were given propofol at three different infusion rates. An infusion of 3 mg.kg-1.h-1 caused minimal changes, but infusion rates of 6 and 12 mg.kg-1.h-1 decreased cerebral blood flow by 28% and 39%, respectively. The changes in cerebral metabolic rate of oxygen were not statistically significant. However, with the two higher infusion rates, there was a trend toward decrease, by 5% and 22%, respectively, for the cerebral metabolic rate of oxygen, and by 18% and 36% for the cerebral metabolic rate of glucose. A 25-30 mm Hg increase in arterial blood pressure had no influence on cerebral blood flow. Replacement of nitrous oxide by nitrogen had no significant influence on cerebral blood flow or metabolism. It is concluded that propofol causes a dose-dependent decrease in cerebral blood flow. However, the study does not prove that this decrease in cerebral blood flow is accompanied by the same degree of decrease in cerebral metabolism. Further studies are clearly needed to clarify propofol's influence on the coupling between cerebral metabolism and blood flow. The physiologic responsiveness of the cerebral circulation to alterations in arterial pressure is well preserved. Propofol appears to prevent the metabolic stimulation and increased cerebral blood flow that has been associated with the administration of nitrous oxide.
N-methyl-D-aspartic acid receptors play an important role during ischemic brain injury. We could not demonstrate that S(+)-ketamine resulted in greater neuroprotective effects compared with remifentanil during cardiopulmonary bypass procedures when both were combined with propofol.
The observed 20% reduction of mortality, 60% reduction of stroke and 20% reduction of dialysis were partly neutralized by the adjusting methods and demand, at least, larger datasets to obtain statistical significance. Subdatasets with fewer patients but higher risk identified risk-reducing effects for stroke. Hospital stay was shortened by the OPCAB approach. The interactions between risk, number of patients and the risk-reducing effect are the cornerstones of evidence generation for the OPCAB approach. These results were obtained through a very strict reengineering and cannot be extended to all OPCAB programs.
The effects of intraarticular bupivacaine administration on postoperative pain and mobilization were evaluated in 97 healthy outpatients undergoing knee arthroscopy under general anesthesia. After completion of the operation, which was performed using a standardized general anesthetic technique, the patient's knee was injected with 30 mL of either 0.5% bupivacaine or saline solution (control), according to a randomized, double-blind protocol. Although there were no statistically significant differences in the patient's assessment of postoperative pain, patients receiving bupivacaine required significantly less opioid analgesic medication in the postoperative period.ocal anesthetics are popular adjuvants during outpatient anesthesia because they can provide L significant intraoperative and postoperative analgesia after a variety of surgical procedures. Although many orthopedic surgeons inject bupivacaine into the intraarticular space after arthroscopic knee surgery, most published studies have failed to demonstrate a significant decrease in postoperative pain (1-3). The lack of an observed analgesic effect may have been the result of using only 0.25% bupivacaine. Higher concentrations of bupivacaine have not been used because of concerns regarding its potential toxicity (i.e., due to rapid uptake through the synovium); however, plasma bupivacaine levels measured after the intraarticular administration of 100 mg of bupivacaine were below toxic levels (2).We assessed the efficacy of bqivacaine, 150 mg (30 mL of 0.5%), in a double-blind, placebo-controlled study. In addition to assessing postoperative pain relief, we also evaluated the effect of local anesthesia on early mobilization after ambulatory arthroscopy.
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