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October 2016: Anaesthesia, Critical Care & Pain Medicine
Mariusz Piechota, Anna Piechota
BACKGROUND: The mortality rate in patients with severe liver dysfunction secondary to alcoholic liver disease (ALD) who do not respond to the standard treatment is exceptionally high. OBJECTIVES: The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support techniques to treat this group of patients. PATIENTS AND METHODS: The data from 23 hospital admissions of 21 patients with ALD who were admitted to the department of anesthesiology and intensive therapy (A&IT) at the Dr Wł...
July 2016: Hepatitis Monthly
Giustino Varrassi, Antonella Paladini
Professor Giustino Varrassi and Antonella Paladini speak to Jade Parker, Commissioning Editor: Professor Giustino Varrassi is Full Professor of Anesthesiology and Pain Medicine in the LUdeS University, Valletta, Malta. He graduated at the Medical School of the University 'La Sapienza' (Rome, Italy) in 1973, and became board certified in Anesthesiology and Intensive Care in 1976 and in Pneumology in 1978, both in the same Medical School. He is currently President of the European League Against Pain and of the Paolo Procacci Foundation, and is a founding member of both of these...
September 19, 2016: Pain Management
Ersin Ercin, M Gokhan Bilgili, Cihangir Sari, S Hakan Basaran, Bulent Tanriverdi, Erdem Edipoglu, K Mumtaz Celen, Halil Cetingok, Cemal Kural
BACKGROUND: Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes...
August 31, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Michael P Leovic, Hailey N Robbins, Michael R Foley, Roman Starikov
Management of the critically-ill pregnant patient presents a clinical dilemma in which there is sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness...
August 20, 2016: American Journal of Obstetrics and Gynecology
Samuel Michael Galvagno, Charles E Smith, Albert J Varon, Erik A Hasenboehler, Shahnaz Sultan, Gregory Shaefer, Kathleen B To, Adam D Fox, Darrell E R Alley, Michael Ditillo, Bellal A Joseph, Bryce R H Robinson, Elliot R Haut
INTRODUCTION: Thoracic trauma is the second most prevalent nonintentional injury in the United States and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework recently adopted by EAST are presented...
November 2016: Journal of Trauma and Acute Care Surgery
Jariya Lertakyamanee
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, has started to be a formal anesthesia division, divided from division of Surgery in 1965; hence our 50th year anniversary in 2015. Research is now a priority and mandatory mission, according to the vision of Mahidol University. Second mission is to teach and train, and we produce the highest number of states-of-the-art anesthesiologists and anesthetic nurses each year Curriculum and training are being continuously improved. From a small unit, now it is one of the largest departments and extends the service, our third mission, to more than only in the operating theaters...
May 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Dimitrios Farmakis, Julian Alvarez, Tuvia Ben Gal, Dulce Brito, Francesco Fedele, Candida Fonseca, Anthony C Gordon, Israel Gotsman, Elena Grossini, Fabio Guarracino, Veli-Pekka Harjola, Yaron Hellman, Leo Heunks, Visnja Ivancan, Apostolos Karavidas, Matti Kivikko, Vladimir Lomivorotov, Dan Longrois, Josep Masip, Marco Metra, Andrea Morelli, Maria Nikolaou, Zoltán Papp, Alexander Parkhomenko, Gerhard Poelzl, Piero Pollesello, Hanne Berg Ravn, Steffen Rex, Hynek Riha, Sven-Erik Ricksten, Robert H G Schwinger, Bojan Vrtovec, M Birhan Yilmaz, Marzenna Zielinska, John Parissis
Levosimendan is a positive inotrope with vasodilating properties (inodilator) indicated for decompensated heart failure (HF) patients with low cardiac output. Accumulated evidence supports several pleiotropic effects of levosimendan beyond inotropy, the heart and decompensated HF. Those effects are not readily explained by cardiac function enhancement and seem to be related to additional properties of the drug such as anti-inflammatory, anti-oxidative and anti-apoptotic ones. Mechanistic and proof-of-concept studies are still required to clarify the underlying mechanisms involved, while properly designed clinical trials are warranted to translate preclinical or early-phase clinical data into more robust clinical evidence...
November 1, 2016: International Journal of Cardiology
Alexandra M Wesolowski, Michael P Zaccagnino, Raymond J Malapero, Alan D Kaye, Richard D Urman
Midazolam, fentanyl, and propofol are commonly used for sedation in modern anesthesia practice. These agents possess characteristics that have afforded various anesthetics to be delivered and produce relatively safe and effective outcomes. However, each agent has certain drawbacks in clinical practice. Remimazolam, a novel benzodiazepine created out of so-called soft drug development, is an ultrashort-acting intravenous sedative-hypnotic currently being investigated in clinical trials. In this review, we evaluate the recent literature on the use of remimazolam in clinical practice as compared with current sedative agents, and we describe its potential roles for use in sedation...
September 2016: Pharmacotherapy
J Biernawska, K Kotfis, M Kaczmarczyk, W Błaszczyk, E Barnik, M Żukowski
BACKGROUND: The autonomic nervous system plays an important role in heart function regulation. One of the most acknowledged methods for noninvasive measurement of autonomic system activity is to determine heart rate variability (HRV). Reduced HRV parameters-heart rate rigidity/stiffness-are an independent prognostic factor of sudden cardiac death risk because of arrhythmia. Renal transplantation is an important factor in HRV changes because of hemodynamic and ion disturbances. The main purpose of this study was to determine the influence of HRV disturbances during renal transplantation procedures on long-term mortality in patients with chronic kidney disease...
June 2016: Transplantation Proceedings
Jan Menzenbach, Olaf Boehm
Before non-cardiac surgery, evaluation of cardiac function is no frequent part of surgical treatment. European societies of anesthesiology and cardiology published consensus-guidelines in 2014 to present a reasonable approach for preoperative evaluation. This paper intends to differentiate the composite of perioperative risk and to display the guidelines methodical approach to handle it. Features to identify patients at risk from an ageing population with comorbidities, are the classification of surgical risk, functional capacity and risk indices...
July 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
O Coşkun, E Yazici, F Şahiner, A Karakaş, S Kiliç, M Tekin, C Artuk, L Yamanel, B A Beşirbellioğlu
AIM: The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation. MATERIALS AND METHODS: In this observational prospective study, 60 adult immunocompetent patients who stayed at least 7 days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued...
July 19, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
A Rand, R J Litz, P Zahn
Spinal cord injuries (SCI) are serious medical conditions, which are associated with severe and potentially fatal risks and complications depending on the location and extent of injury. Traffic accidents, falls and recreational activities are the leading causes for traumatic SCI (TSCI) worldwide whereas non-traumatic spinal cord injuries (NTSCI) are mostly due to tumors and congenital diseases. As chronification of the injuries progresses other organ systems are affected including anatomical changes, the respiratory and cardiovascular systems and endocrinological pathways...
July 2016: Der Anaesthesist
Tihana Magdić Turković, Anita Lukić, Iva Pažur, Ognjen Ožegić, Melanija Obraz
Ventilator-associated pneumonia (VAP) is the most common infection among intensive care unit (ICU) patients. The aim of the present study was to evaluate the impact of tracheotomy on VAP clinical course. The study was conducted in a 15-bed Surgical and Neurosurgical ICU, Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients developing VAP during ICU stay were eligible for the study. In VAP patients not tracheotomized during ICU stay, the mortality rate was approximately two times higher as compared with patients tracheotomized either before or after VAP onset (crude risk ratio 1...
March 2016: Acta Clinica Croatica
K Umgelter, J Landscheidt, K Jäger, M Blobner, E Kochs
BACKGROUND: Perioperative care demands consideration of individual treatment goals. We evaluated the attitudes of medical staff towards a short standardized advance directive (SSAD) as a means of improving patient-orientated care at the transition from operating theater to general or intensive care wards. METHOD: Multicenter anonymized standardized multiple-choice questionnaire among physicians and nurses from various operative and anesthesiology departments. Questions addressing demographic parameters and attitudes towards advance directives in acute care settings (eleven 4‑stepped Likert items)...
July 2016: Der Anaesthesist
Anna T Mazzeo, Iacopo Battaglini, Luca Brazzi, Luciana Mascia
Preventing neurological injury is mandatory during the perioperative period of any kind of surgery and in the care of critically ill patients in the intensive care unit. During daily practice, both anaesthesiologists and neurologists focus on brain protection as an integral part of systemic homeostasis maintenance. This article highlights the intriguing overlap between anaesthesiology and neurology in clinical practice along with its potential implications for outcome. Moreover, it focuses on the importance of the complementary expertise of both specialists in maintaining cerebral homeostasis, with the aim of improving outcome...
June 17, 2016: Minerva Anestesiologica
Amit Tyagi, Shivani Rastogi, Manoj Tripathi, Rajlaxmi Bhandari, Prateek Singh Bais, Mahendra Singh
CONTEXT: The continued success of regional anesthetic techniques can be credited due to improved local anesthetic drugs, with lower toxicities and longer duration of action, but still many efforts are being done to increase the duration of the block and postoperative analgesia. Therefore, use of adjuvant drugs for anesthesia is intended to prolong analgesia and preventing deleterious clinical effects of local anesthetics. AIMS: The present study is designed to evaluate effects of intrathecal hyperbaric bupivacaine versus hyperbaric bupivacaine with low dose clonidine on the onset and level of sensory and motor block, the intensity of motor blockade, and time of analgesia required in the postoperative period...
May 2016: Anesthesia, Essays and Researches
A V Schegolev, A A Andreenko, E N Ershov, R E Lahin, E P Makarenko
The modern system of medical education requires objective methods to assess clinical competence of medical specialists. Application of objective structured clinical examination (OSCE) during the final certification of graduates of clinical residency allows to evaluate the theoretical knowledge, manual skills. Enabling simulation scenarios in the program makes it possible to objectively evaluate the important non-technical skills of anesthesiologists, identify gaps in the system of training and modify it. The experience of the objective structured clinical examination as part of the state certification of graduates of clinical residency of the Department ofAnesthesiology and Intensive Care, Military MedicalAcademy after C M Kirov allows us to consider this technique in an objective way a comprehensive assessment of the competence of health professionals...
January 2016: Anesteziologiia i Reanimatologiia
V Pudová, M Htoutou Sedláková, M Kolář
Hospital-acquired pneumonia (HAP) is one of the most serious complications in patients staying in intensive care units. This multicenter study of Czech patients with HAP aimed at assessing the clonality of bacterial pathogens causing the condition. Bacterial isolates were compared using pulsed-field gel electrophoresis. Included in this study were 330 patients hospitalized between May 1, 2013 and December 31, 2014 at departments of anesthesiology and intensive care medicine of four big hospitals in the Czech Republic...
September 2016: Current Microbiology
W Klingler, E Pfenninger
Pharmacotherapy is a key component of anesthesiology and intensive care medicine. The individual genetic profile influences not only the effect of pharmaceuticals but can also completely alter the mode of action. New technologies for genetic screening (e.g. next generation sequencing) and increasing knowledge of molecular pathways foster the disclosure of pharmacogenetic syndromes, which are classified as rare diseases. Taking into account the high genetic variability in humans and over 8000 known rare diseases, up to 20 % of the population may be affected...
May 2016: Der Anaesthesist
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