Measuring Cardiac Output in the Critically Ill

__Abstract__ Haemodynamic monitoring plays an essential part on the care of the critically ill patient. Monitoring has two goals; the first goal is a signalling function if the patients clinical condition improves or deteriorates adequate measures can be taken. Maintaining the adequacy of the circulation reduces the chance of inadequate oxygen transport to the tissues preventing organ ischemia. The second goal is using the monitoring as a decision making tool. Historically, arterial pressures were measured because they were easier to measure than bloodflow. But the introduction of the pulmonary artery catheter (PAC) in 1970 allowed the regular measurement of cardiac output (CO) at the beside. Beside CO a new array of variables could be monitored. Measuring more variables did not automatically relate to better outcomes

Genetic architecture of Environmental Sensitivity reflects multiple heritable components: a twin study with adolescents

Humans differ substantially in how strongly they respond to similar experiences. Theory suggests that such individual differences in susceptibility to environmental influences have a genetic basis. The present study investigated the genetic architecture of Environmental Sensitivity (ES) by estimating its heritability, exploring the presence of multiple heritable components and its genetic overlap with common personality traits. ES was measured with the Highly Sensitive Child (HSC) questionnaire and heritability estimates were obtained using classic twin design methodology in a sample of 2868 adolescent twins. Results indicate that the heritability of sensitivity was 0.47, and that the genetic influences underlying sensitivity to negative experiences are relatively distinct from sensitivity to more positive aspects of the environment, supporting a multi-dimensional genetic model of ES. The correlation between sensitivity, neuroticism and extraversion was largely explained by shared genetic influences, with differences between these traits mainly attributed to unique environmental influences operating on each trait

A practical drug discovery project at the undergraduate level

A practical drug discovery project for third-year undergraduates is described. No previous knowledge of medicinal chemistry is assumed. Initial lecture-workshops cover the basic principles; then students are asked to improve the profile of a weakly potent, poorly soluble PI3K inhibitor (1). Compound array design, molecular modelling and screening data analysis are followed by laboratory work in which each student, as part of a team, attempts to synthesise at least two target compounds. The project benefits from significant industrial support, including lectures, student mentoring and consumables. The aim is to make the learning experience as close as possible to real-life industrial situations. Forty-eight target compounds have been prepared, the best of which (5b, 5j, 6b and 6ap) improved the potency and aqueous solubility of the lead compound (1) by 100-1000 fold and 10-fold, respectively

The smaller the better?

Contains fulltext : 175670.pdf (publisher's version ) (Open Access

Spinal anesthesia: the Holy Grail?

Contains fulltext : 175658.pdf (publisher's version ) (Open Access

Not everything that can be done should be done

Cor Slagt Radboud University Medical Center, Department Anaesthesia, Pain and Palliative Medicine, Nijmegen, the NetherlandsAfter reading the article, “Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency” by Mehta et al,1 I have the following considerations. Laparoscopic cholecystectomy was performed under spinal anesthesia in healthy patients.2 Perioperative hemodynamic instability (59%) and discomfort (43%) were noticed in this group of 49 patients. From the gastroenterology literature, we know that a combination of lumbar spinal and thoracic epidural anesthesia can be used as a monotherapy for high-risk patients undergoing gastrointestinal and colorectal surgery.3 Perioperative hemodynamics and discomfort were not observed in 12 patients. Is this a stress-free environment? Preventing general anesthesia should not be a goal on its own. From an oxygen delivery-consumption point of view, general anesthesia reduces oxygen consumption and can promote oxygen delivery, theoretically preventing organ failure, especially in high-risk surgical patients with diseases that involve multiple organs.4 Our body has protected the delicate spinal cord by the vertebral column. Damaging the spinal cord during anesthesia, for instance, during epidural procedures, is one of the greatest fears of our patients and anesthesiologists.5,6 New techniques should be thoroughly tested on healthy patients before they are used on high-risk surgical patients. A combined thoracic spinal epidural anesthesia is, in the light of the above, an undesirable technique, especially combined with pneumoperitoneum when hemodynamic and respiratory homeostasis and patient comfort can be compromised. Although there is the possibility to place a thoracic combined spinal epidural anesthesia, I strongly like to emphasize that especially in the view of patient safety, this procedure is undesirable. A thoracic epidural combined with general anesthesia is in the most cases (if not all cases) a safe alternative.View original paper by Mehta and colleagues

Is Off-pump cardiac surgery ready for goal-directed therapy?

Contains fulltext : 175551.pdf (Publisher’s version ) (Open Access

Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Letter]

Contains fulltext : 215193.pdf (publisher's version ) (Open Access