We hypothesized that different phases of intraoperative hypotension should be differentiated because of different underlying causative mechanisms. We defined post-induction hypotension (PIH; i.e. ...arterial hypotension occurring during the first 20 min after anaesthesia induction) and early intraoperative hypotension (eIOH; i.e. arterial hypotension during the first 30 min of surgery).
In this retrospective study, we included 2037 adult patients who underwent general anaesthesia. Arterial hypotension was defined as a systolic arterial blood pressure (SAP) <90 mm Hg or a need for norepinephrine infusion at > 6 µg min−1 at least once during the phases of PIH and eIOH. Multivariate logistic regression analysis was used to test for association of clinical factors with PIH and eIOH.
Independent variables significantly related to PIH were pre-induction SAP odds ratio (OR) 0.97 (95% confidence interval 0.97–0.98), age OR 1.03 (1.02–1.04), and emergency surgery OR 1.75 (1.20–2.56); P<0.01 each. Pre-induction SAP OR 0.99 (0.98–0.99), P<0.01, age OR 1.02 (1.02–1.03), P<0.01, emergency surgery OR 1.83 (1.28–2.62), P<0.01, supplementary administration of spinal or epidural anaesthetic techniques OR 3.57 (2.41–5.29), P<0.01, male sex OR 1.41 (1.12–1.79), P<0.01, and ASA physical status IV OR 2.18 (1.19–3.99), P=0.01 were significantly related to eIOH.
We identified clinical factors associated with PIH and eIOH. The use of these factors to estimate the risk of PIH and eIOH might allow the avoidance or timely treatment of hypotensive episodes during general anaesthesia.
The determination of blood flow, i.e. cardiac output, is an integral part of haemodynamic monitoring. This is a review on noninvasive continuous cardiac output monitoring in perioperative and ...intensive care medicine. We present the underlying principles and validation data of the following technologies: thoracic electrical bioimpedance, thoracic bioreactance, vascular unloading technique, pulse wave transit time, and radial artery applanation tonometry. According to clinical studies, these technologies are capable of providing cardiac output readings noninvasively and continuously. They, therefore, might prove to be innovative tools for the assessment of advanced haemodynamic variables at the bedside. However, for most technologies there are conflicting data regarding the measurement performance in comparison with reference methods for cardiac output assessment. In addition, each of the reviewed technology has its own limitations regarding applicability in the clinical setting. In validation studies comparing cardiac output measurements using these noninvasive technologies in comparison with a criterion standard method, it is crucial to correctly apply statistical methods for the assessment of a technology's accuracy, precision, and trending capability. Uniform definitions for ‘clinically acceptable agreement’ between innovative noninvasive cardiac output monitoring systems and criterion standard methods are currently missing. Further research must aim to further develop the different technologies for noninvasive continuous cardiac output determination with regard to signal recording, signal processing, and clinical applicability.
Lung-protective ventilation is claimed to be beneficial not only in critically ill patients, but also in pulmonary healthy patients undergoing general anaesthesia. We report the use of electrical ...impedance tomography for assessing regional changes in ventilation, during both spontaneous breathing and mechanical ventilation, in patients undergoing robot-assisted radical prostatectomy.
We performed electrical impedance tomography measurements in 39 patients before induction of anaesthesia in the sitting (M1) and supine position (M2), after the start of mechanical ventilation (M3), during capnoperitoneum and Trendelenburg positioning (M4), and finally, in the supine position after release of capnoperitoneum (M5). To quantify regional changes in lung ventilation, we calculated the centre of ventilation and ‘silent spaces’ in the ventral and dorsal lung regions that did not show major impedance changes.
Compared with the awake supine position 2.3% (2.3), anaesthesia and mechanical ventilation induced a significant increase in silent spaces in the dorsal dependent lung 9.2% (6.3); P <0.05. Capnoperitoneum and the Trendelenburg position led to a significant increase in such spaces 11.5% (8.9). Silent space in the ventral lung remained constant throughout anaesthesia.
Electrical impedance tomography was able to identify and quantify on a breath-by-breath basis circumscribed areas, so-called silent spaces, within healthy lungs that received little or no ventilation during general anaesthesia, capnoperitoneum, and different body positions. As these silent spaces are suggestive of atelectasis on the one hand and overdistension on the other, they might become useful to guide individualized protective ventilation strategies to mitigate the side-effects of anaesthesia and surgery on the lungs.
Objectives
To evaluate the recommendations for multiparametric prostate MRI (mp-MRI) interpretation introduced in the recently updated Prostate Imaging Reporting and Data System version 2 ...(PI-RADSv2), and investigate the impact of pathologic tumour volume on prostate cancer (PCa) detectability on mpMRI.
Methods
This was an institutional review board (IRB)-approved, retrospective study of 150 PCa patients who underwent mp-MRI before prostatectomy; 169 tumours ≥0.5-mL (any Gleason Score GS) and 37 tumours <0.5-mL (GS ≥4+3) identified on whole-mount pathology maps were located on mp-MRI consisting of T2-weighted imaging (T2WI), diffusion-weighted (DW)-MRI, and dynamic contrast-enhanced (DCE)-MRI. Corresponding PI-RADSv2 scores were assigned on each sequence and combined as recommended by PI-RADSv2. We calculated the proportion of PCa foci on whole-mount pathology correctly identified with PI-RADSv2 (dichotomized scores 1–3 vs. 4–5), stratified by pathologic tumour volume.
Results
PI-RADSv2 allowed correct identification of 118/125 (94 %; 95 %CI: 90–99 %) peripheral zone (PZ) and 42/44 (95 %; 95 %CI: 89–100 %) transition zone (TZ) tumours ≥0.5 mL, but only 7/27 (26 %; 95 %CI: 10–42 %) PZ and 2/10 (20 %; 95 %CI: 0–52 %) TZ tumours with a GS ≥4+3, but <0.5 mL. DCE-MRI aided detection of 4/125 PZ tumours ≥0.5 mL and 0/27 PZ tumours <0.5 mL.
Conclusions
PI-RADSv2 correctly identified 94–95 % of PCa foci ≥0.5 mL, but was limited for the assessment of GS ≥4+3 tumours ≤0.5 mL. DCE-MRI offered limited added value to T2WI+DW-MRI.
Key points
• PI-RADSv2 correctly identified 95 % of PCa foci ≥0.5 mL
• PI-RADSv2 was limited for the assessment of GS ≥4+3 tumours ≤0.5 mL
• DCE-MRI offered limited added value to T2WI+DW-MRI
Coherent manipulation of quantum bits (qubits) on timescales much shorter than the coherence time is a key prerequisite for quantum information processing. Electron spins in quantum dots are ...particularly attractive for implementations of qubits, and efficient optical methods for initialization and readout of spins have been developed in recent years. Spin coherence times in the microsecond range have been demonstrated. Therefore, spin control by picosecond optical pulses would be highly desirable so that a large number of spin rotations could be carried out while coherence is maintained. A major remaining challenge is demonstration of such rotations with high fidelity. Here, we use an ensemble of quantum-dot electron spins focused into a small number of precession modes about a magnetic field by periodic optical pumping. We demonstrate ultrafast optical rotations of spins about arbitrary axes on a picosecond timescale using laser pulses as control fields.
The hyperfine interaction of an electron with the nuclei is considered as the primary obstacle to coherent control of the electron spin in semiconductor quantum dots. We show, however, that the ...nuclei in singly charged quantum dots act constructively by focusing the electron spin precession about a magnetic field into well-defined modes synchronized with a laser pulse protocol. In a dot with a synchronized electron, the light-stimulated fluctuations of the hyperfine nuclear field acting on the electron are suppressed. The information about electron spin precession is imprinted in the nuclei and thereby can be stored for tens of minutes in darkness. The frequency focusing drives an electron spin ensemble into dephasing-free subspaces with the potential to realize single frequency precession of the entire ensemble.
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