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Sepsis, stroke, anesthesia

Jessica Noel-Morgan, William W Muir
Although the utility and benefits of anesthesia and analgesia are irrefutable, their practice is not void of risks. Almost all drugs that produce anesthesia endanger cardiovascular stability by producing dose-dependent impairment of cardiac function, vascular reactivity, and compensatory autoregulatory responses. Whereas anesthesia-related depression of cardiac performance and arterial vasodilation are well recognized adverse effects contributing to anesthetic risk, far less emphasis has been placed on effects impacting venous physiology and venous return...
2018: Frontiers in Veterinary Science
Josh D Bell, Kushlin Higgie, Mital Joshi, Joshua Rucker, Sahar Farzi, Naveed Siddiqui
MELAS syndrome (mitochondrial encephalopathy, lactic acidosis, and stroke-like symptoms) is a rare and complex mitochondrial disorder. We present the in-hospital course of a 36-year-old gravida 2, para 0 with MELAS syndrome and severe preeclampsia, complicated by hyponatremia, hyperkalemia, and diabetes. A retained placenta with postpartum hemorrhage required urgent instrumental delivery under spinal anesthesia, transfusion, and intensive care unit admission for pulmonary edema, effusions, and atelectasis. Postpartum endometritis and sepsis also were encountered...
July 15, 2017: A & A Case Reports
You-Lin Nie, Ming-Chih Lin, Wei-Wen Lin, Chung-Chi Wang, Ching-Pei Chen, Chia-Hsun Lin, Tsung-Cheng Shyu, Yeak-Wun Quek, Sheng-Ling Jan, Yun-Ching Fu
BACKGROUND: Transcatheter device closure of postmyocardial infarction ventricular septal defect (PMIVSD) is less invasive than surgical repair. However, its feasibility, timing, outcome, and prognostic factors remain unclear. METHODS: This was a multicenter, retrospective cohort study. Between February 2012 and July 2015, a total of 10 (8 male and 2 female) patients with PMIVSD undergoing attempted device closure were enrolled retrospectively. The procedures were performed under general anesthesia with fluoroscopic and transesophageal echocardiographic guidance...
January 2017: Journal of the Chinese Medical Association: JCMA
Yu-Chi Tung, Ya-Hui Hsu, Guann-Ming Chang
Hip fractures are a global public health problem. During surgery following hip fractures, both general and regional anesthesia are used, but which type of anesthesia offers a better outcome remains controversial. There has been little research evaluating different anesthetic types on mortality and readmission rates for hip fracture surgery using nationwide population-based data.We used nationwide population-based data to examine the effect of anesthetic type on mortality and readmission rates for hip fracture surgery...
April 2016: Medicine (Baltimore)
Junichi Ohya, Yasushi Oshima, Hirotaka Chikuda, Takeshi Oichi, Hiroki Matsui, Kiyohide Fushimi, Sakae Tanaka, Hideo Yasunaga
OBJECTIVE Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation. METHODS The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013...
February 2016: Neurosurgical Focus
Kasana Raksamani, Pornsiri Wannadilok, Worawong Slisatkorn
BACKGROUND: The thoracic endovascular aortic repair (TEVAR) has become popular due to its favorable immediate outcome. However, the outcome in longer duration is still questionable. The aim of the present study was to analyze the incidence and risk factors associated with 90 days mortality after TEVAR. MATERIAL AND METHOD: After the Siriraj Institutional Review Board, Thailand approved and waived the needfor the informed consent, the database that included 160 consecutive patients having TEVAR procedures between December 2006 and December 2010 was examined Patients' characteristics, including operative procedures and anesthesia techniques were studied...
April 2015: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Joseph A Hyder, J Kyle Bohman, Daryl J Kor, Arun Subramanian, Edward A Bittner, Bradly J Narr, Robert R Cima, Victor M Montori
BACKGROUND: A patient undergoing surgery may receive anesthesia care from several anesthesia providers. The safety of anesthesia care transitions has not been evaluated. Using unconditional and conditional multivariable logistic regression models, we tested whether the number of attending anesthesiologists involved in an operation was associated with postoperative complications. METHODS: In a cohort of patients undergoing elective colorectal surgical in an academic tertiary care center with a stable anesthesia care team model participating in the American College of Surgeons National Surgical Quality Improvement Program, using unconditional and conditional multivariable logistic regression models, we tested adjusted associations between numbers of attending anesthesiologists and occurrence of death or a major complication (acute renal failure, bleeding that required a transfusion of 4 units or more of red blood cells within 72 hours after surgery, cardiac arrest requiring cardiopulmonary resuscitation, coma of 24 hours or longer, myocardial infarction, unplanned intubation, ventilator use for 48 hours or more, pneumonia, stroke, wound disruption, deep or organ-space surgical-site infection, superficial surgical-site infection, sepsis, septic shock, systemic inflammatory response syndrome)...
January 2016: Anesthesia and Analgesia
Ronald P M Gonçalves, Karla L Guarido, Jamil Assreuy, J Eduardo da Silva-Santos
The aim of the present study was to investigate the existence of gender-related differences in the profile of changes that occur in cardiac functionality during endotoxic shock. For this, both male and female Wistar rats received a single injection of lipopolysaccharide (LPS; 10 mg/kg, i.p.) at 6 h (LPS 6-h group) or 24 h (LPS 24-h group) before the induction of anesthesia and insertion of a pressure-volume catheter using the closed-chest method. Control animals received sterile saline. Hemodynamic parameters were recorded under basal conditions and during the peak of the pressor effect of phenylephrine (30 nmol/kg i...
November 2014: Shock
Jeremie Lemarie, Alice Blet, Youcef Bouazza, Julie Boisrame-Helms, Ferhat Meziani, Bruno Levy
Corticosteroids have been shown to reduce short-term mortality during septic shock and therefore recommended in the most severe patients as adjuvant therapy. Until recently, recombinant human activated protein C (APC) was also considered in the management of more severe cases. As myocardial depression has long been recognized as a manifestation of organ dysfunction during septic shock, we examined whether corticosteroids (dexamethasone, 150 µg/kg per hour) and/or APC (33 µg/kg per hour) treatments improve sepsis-induced cardiac dysfunction during cecal ligature and puncture-induced septic shock in Wistar rats...
June 2014: Shock
Georg M Fröhlich, Alexandra J Lansky, John Webb, Marco Roffi, Stefan Toggweiler, Markus Reinthaler, Duolao Wang, Nevil Hutchinson, Olaf Wendler, David Hildick-Smith, Pascal Meier
BACKGROUND: The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR).TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported. METHODS: This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR...
2014: BMC Medicine
Ching-Wei D Tzeng, Matthew H G Katz, Jason B Fleming, Jeffrey E Lee, Peter W T Pisters, Holly M Holmes, Gauri R Varadhachary, Robert A Wolff, James L Abbruzzese, Jean-Nicolas Vauthey, Thomas A Aloia
BACKGROUND: We previously described the clinical classification of patients with resectable pancreatic tumor anatomy but marginal performance status (PS) or reversible comorbidities as "borderline resectable type C" (BR-C). This study was designed to analyze the incidence and risk factors for post-pancreaticoduodenectomy (PD) morbidity/mortality in a multi-institutional cohort of BR-C patients. METHODS: Elective PDs were evaluated from the 2005-10 ACS-NSQIP database...
January 2014: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Edward Sawey, Steven Hollenberg, Sergio Zanotti
SESSION TYPE: Pharmacology in the ICU PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Animal models of disease often use anesthesia, which can influence hemodynamics and cardiac function. Our purpose was to compare cardiac function in mice under light isoflurane anesthesia with cardiac function in unanesthetized mice.METHODS: Wild type C57BL/6 mice (n=13) were anesthetized with isoflurane, via nose cone, titrated to the lowest dose necessary to achieve non-response to distal tail pinch; doses ranged from 0...
October 1, 2012: Chest
Hidemasa Takahashi, Kyouko Tagawa, Takeo Suzuki
BACKGROUND: Goal directed therapy (GDT) is applied during the initial resuscitation of sepsis, known as early goal directed therapy (EGDT). Recent studies in major abdominal surgery suggested that anesthetic management with GDT may decrease morbidity and hospital stay. We have utilized GDT in major invasive surgery such as pancreatoduodenectomy in November 2009. METHODS: In the anesthetic management of pancreatoduodenectomy, 11 patients managed by GDT were compared concerning postoperative hospital stay with 11 patients managed by conventional methods retrospectively...
October 2012: Masui. the Japanese Journal of Anesthesiology
Prateek K Gupta, Jason N Mactaggart, Bala Natarajan, Thomas G Lynch, Shipra Arya, Himani Gupta, Xiang Fang, Iraklis I Pipinos
OBJECTIVE: The use of fenestrated and branched stent graft technology for paravisceral abdominal aortic aneurysms (PAAA) is on the rise; however, its application is limited in the United States to only a few selected centers. Most PAAAs are currently repaired using an open approach. The objective of this study was to determine which patients are at highest risk with open PAAA repair and might benefit most from endovascular repair using fenestrated or branched stent grafts. METHODS: This was a retrospective cohort study using data from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hospitals...
March 2012: Journal of Vascular Surgery
John G T Augoustides
Steroids and statins may facilitate the integration of anesthetic design with clinical outcome. Although steroids clearly benefit adult cardiac surgical patents, the evidence is weaker in pediatric cardiac surgery. Current large randomized trials of steroids likely will determine the future role of steroids in adult cardiac surgery. In the intensive care unit, steroid therapy is indicated in septic shock that is refractory to fluid and pressor therapy. Recent data, however, indicate that liberal steroid therapy for sepsis may have adverse outcome consequences...
October 2011: Journal of Cardiothoracic and Vascular Anesthesia
Carmelina Gurrieri, Jonathon E Kivela, Katarina Bojanić, Ralitza H Gavrilova, Randall P Flick, Juraj Sprung, Toby N Weingarten
PURPOSE: Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS) is a rare inherited mitochondrial disorder associated with severe multiorgan pathology and stress-induced episodes of metabolic decompensation and lactic acidosis. The purpose of this case series is to review the medical records of patients with MELAS who underwent anesthetic care at the Mayo Clinic to observe their perioperative responses to anesthesia and to assess outcomes. PRINCIPAL FINDINGS: From September 1997 to October 2010, nine patients with MELAS were identified who underwent 20 general anesthetics, 12 prior to MELAS diagnosis...
August 2011: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Catherine A Theodosiou, Ruth E Loeffler, Angela J Oglesby, Dermot W McKeown, David C Ray
AIM: Our primary objective was to evaluate the characteristics and outcomes of elderly (≥ 80 years) patients undergoing rapid sequence induction of anaesthesia and intubation (RSI) in our emergency department (ED). METHODS: We retrospectively analysed data collected prospectively between January 1999 and December 2007. We retrieved age; gender; presenting diagnosis; indication and urgency for RSI; complications related to RSI; hospital destination; and outcome...
July 2011: Resuscitation
D Eissa, E G Carton, D J Buggy
Severe sepsis, a syndrome characterized by systemic inflammation and acute organ dysfunction in response to infection, is a major healthcare problem affecting all age groups throughout the world. Anaesthetists play a central role in the multidisciplinary management of patients with severe sepsis from their initial deterioration at ward level, transfer to the diagnostic imaging suite, and intraoperative management for emergency surgery. The timely administration of appropriate i.v. antimicrobial therapy is a crucial step in the care of patients with severe sepsis who may require surgery to control the source of sepsis...
December 2010: British Journal of Anaesthesia
Basem Abdelmalak, Ankit Maheshwari, Edward Mascha, Sunita Srivastava, Theodore Marks, Wh Wilson Tang, Andrea Kurz, Daniel I Sessler
BACKGROUND: The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia. METHODS/DESIGN: The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs...
June 30, 2010: BMC Anesthesiology
Katja Baumgart, Vladislava Simkova, Florian Wagner, Sandra Weber, Michael Georgieff, Peter Radermacher, Gerd Albuszies, Eberhard Barth
PURPOSE: To test the hypothesis whether genetic over-expression of the Cu/Zn-superoxide dismutase (SOD-1) prevents the sepsis-related impairment of myocardial function and norepinephrine responsiveness in a resuscitated murine model of septic shock. METHODS: Fifteen hours after cecal ligation and puncture or sham-operation wild type, heterozygous and homozygous SOD-1 over-expressing mice were anesthetized, ventilated and instrumented with central venous and left ventricular pressure-conductance catheters, to assess heart function at 18, 21, and 24 h after CLP or sham-operation...
February 2009: Intensive Care Medicine
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