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https://www.readbyqxmd.com/read/28734732/perinatal-and-neonatal-use-of-sedation-and-analgesia
#1
REVIEW
Christopher McPherson, Terrie Inder
Optimal obstetric and neonatal care requires the provision of adequate analgesia for painful procedures. However, anesthetic and analgesic agents have the potential to adversely impact the developing fetal/neonatal brain. In this setting, clinicians must assess the risks and benefits of pharmacologic anesthesia and analgesia for specific indications in this population. General anesthesia is required for non-obstetric surgery and cesarean section in the absence of neuraxial anesthesia for the health of the mother and fetus...
July 19, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28731876/neuraxial-drug-delivery-for-the-management-of-cancer-pain-cost-updates-and-society-guidelines
#2
Collin F M Clarke
PURPOSE OF REVIEW: The present study discusses the utilization of neuraxial drug delivery (NDD) for the management of cancer pain, based on recent trials, reviews, and guidelines with a focus on cost analysis. RECENT FINDINGS: Almost all recent publications suggest that more stringent research is needed to improve evidence on NDD, particularly as conflicting reports exist regarding cost effectiveness of drug delivery systems. The combination of local anesthetics and opioids, with or without clonidine, continues to be reported as beneficial with the utilization of patient controlled systems providing an advantage over continuous ones...
July 20, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28723831/effect-of-intrathecal-bupivacaine-dose-on-the-success-of-external-cephalic-version-for-breech-presentation-a-prospective-randomized-blinded-clinical-trial
#3
Laurie A Chalifoux, Jeanette R Bauchat, Nicole Higgins, Paloma Toledo, Feyce M Peralta, Jason Farrer, Susan E Gerber, Robert J McCarthy, John T Sullivan
BACKGROUND: Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose-response effect. We hypothesized that increasing the intrathecal bupivacaine dose would be associated with increased external cephalic version success...
July 19, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28719524/establishing-obstetric-anesthesiology-practice-guidelines-in-the-republic-of-armenia-a-global-health-collaboration
#4
Gordon Yuill, Ashot Amroyan, Simon Millar, Emil Vardapetyan, Ashraf S Habib, Medge D Owen
BACKGROUND: Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia...
August 2017: Anesthesiology
https://www.readbyqxmd.com/read/28711179/immediate-birth-an-analysis-of-women-and-their-babies-undergoing-time-critical-birth-in-a-tertiary-referral-obstetric-hospital
#5
M H Warren, J Kamania, A T Dennis
BACKGROUND: At our institution, the emergency obstetric 'code green' activates the system for immediate birth, usually by caesarean section. This study aimed to determine the incidence of immediate birth, indications, modes of anaesthesia, and short-term neonatal and maternal outcomes. METHOD: A review was performed for all women at the Royal Women's Hospital, Parkville, Australia who underwent immediate birth over a two-year period: January 1, 2013 to December 31, 2014...
June 16, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28709756/postoperative-outcomes-associated-with-neuraxial-vs-general-anesthesia-following-bilateral-total-knee-arthroplasty
#6
Jeffrey B Walker, Patrick L Nguyen, Ulrich H Schmidt, Rodney A Gabriel
BACKGROUND: There is sparse evidence on the benefit of neuraxial (NA) vs general anesthesia (GA) as the primary anesthetic in postoperative outcomes following bilateral total knee arthroplasty. We sought to elucidate differences in outcomes in this surgical population using a national database. METHODS: We used data from the National Surgical Quality Improvement Program from 2007 to 2013 and compared rates of various postoperative outcomes in propensity-matched cohorts (NA vs GA)...
June 23, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28708666/socioeconomic-deprivation-and-utilization-of-anesthetic-care-during-pregnancy-and-delivery-a-french-retrospective-multicenter-cohort-study
#7
Elie Kantor, Jean Guglielminotti, Elie Azria, Dominique Luton, Mandelbrot Laurent, Oury Jean-François, Dominique Mahieu-Caputo, Philippe Ravaud, Candice Estellat
BACKGROUND: Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery...
July 13, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28706559/insights-into-the-roles-of-midazolam-in-cancer-therapy
#8
REVIEW
Jinghua Jiao, Yuheng Wang, Xiaofeng Sun, Xiaojing Jiang
With its high worldwide mortality and morbidity, cancer has gained increasing attention and novel anticancer drugs have become the focus for cancer research. Recently, studies have shown that most anesthetic agents can influence the activity of tumor cells. Midazolam is a γ-aminobutyric acid A (GABAA) receptor agonist, used widely for preoperative sedation and as an adjuvant during neuraxial blockade. Some studies have indicated the potential for midazolam as a novel therapeutic cancer drug; however, the mechanism by which midazolam affects cancer cells needs to be clarified...
2017: Evidence-based Complementary and Alternative Medicine: ECAM
https://www.readbyqxmd.com/read/28705534/neuraxial-labor-analgesia-is-not-an-independent-predictor-of-perineal-lacerations-after-vaginal-delivery-of-patients-with-intrauterine-fetal-demise
#9
Ji H Lee, Feyce M Peralta, Anna Palatnik, Christina Lewicky Gaupp, Robert J McCarthy
INTRODUCTION: The role of neuraxial labor analgesia in perineal trauma following live births is controversial, and no studies have assessed the association in women delivering an intrauterine fetal demise. We evaluated the relationship between neuraxial labor analgesia and perineal laceration in these patients. METHODS: This was a retrospective case-control study of women with a diagnosis of fetal death after 20weeks of gestation, a vaginal delivery, and an Apgar score of 0 at delivery, during the period from January 2007 through December 2015...
June 1, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28702752/proximal-tibial-extra-axial-chordoma-masquerading-as-renal-cell-carcinoma-metastasis
#10
Jennifer Huang, Nicholas Bhojwani, Fredrick D Oakley, Martin I Jordanov
Chordomas are rare, locally aggressive notochordal tumors, which most frequently occur in the neuraxis. We describe the case of a 74-year-old male with a history of renal cell carcinoma, who presented with a slowly enlarging mass in his left leg. While the clinical history and imaging suggested metastatic renal cell carcinoma, immunohistochemical staining with brachyury ultimately made the diagnosis of extra-axial chordoma. At 74 years of age, our patient is the oldest ever reported with bony extra-axial chordoma objectively confirmed by brachyury staining...
July 12, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28700615/astrocyte-heterogeneity-across-the-brain-and-spinal-cord-occurs-developmentally-in-adulthood-and-in-response-to-demyelination
#11
Hyesook Yoon, Grant Walters, Alex R Paulsen, Isobel A Scarisbrick
Astrocytes have emerged as essential regulators of function and response to injury in the brain and spinal cord, yet very little is known about regional differences that exist. Here we compare the expression of key astroglial markers (glial fibrillary acidic protein (GFAP) and Aldehyde Dehydrogenase-1 Family Member L1 (ALDH1L1)) across these disparate poles of the neuraxis, tracking their expression developmentally and in the context of demyelination. In addition, we document changes in the astrocyte regulatory cytokine interleukin 6 (IL-6), and its signaling partner signal transducer and activator of transcription 3 (STAT3), in vivo and in vitro...
2017: PloS One
https://www.readbyqxmd.com/read/28696947/regional-blocks-carried-out-during-general-anesthesia-or-deep-sedation-myths-and-facts
#12
Peter Marhofer
PURPOSE OF REVIEW: More patients will accept regional blocks if these are performed during sedation or general anesthesia. This review discusses regional anesthesia in sedated or anesthetized patients. RECENT FINDINGS: As complications of regional blocks are rare, regional anesthesia can be considered aswell-tolerated. Awake patients will notice only a minority of needle-to-nerve contacts, that renders the notion of a 'live monitor' obsolete. Using high-resolution ultrasound, the needle can be advanced to an extraepineural position for injection, thus strictly avoiding needle-to-nerve contact or intraepineural injection of local anesthetic...
July 10, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28691978/occam-s-razor-could-not-cut-it-tale-of-2-headaches-in-a-postpartum-patient-a-case-report
#13
James A Dolak, Constantinos G Hadjipanayis, Linda J Demma
Not all postpartum headaches are caused by dural puncture, and it is possible for postpartum patients to have >1 cause for headache. After neuraxial block with an incidental large-gauge dural puncture, our patient developed a severe, classic postdural puncture headache which initially responded to an epidural blood patch. The patient was readmitted 2 days after discharge complaining of recurrent headache less characteristic of a postdural puncture headache, now being bifrontal/retro-orbital and without clear positional component...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28687146/intravenous-dexmedetomidine-for-cesarean-delivery-and-its-concentration-in-colostrum
#14
M Yoshimura, T Kunisawa, M Suno, A Sugawara, A Kurosawa, R Nakanishi, K Aoki, T Toriumi
BACKGROUND: Dexmedetomidine is a sedative agent with high α2-adrenoreceptor selectivity. We investigated intravenous Dexmedetomidine administration during scheduled cesarean delivery under neuraxial anesthesia; and concentration in the colostrum. METHODS: Twenty-seven participants having elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. After delivery and cord clamping, 6μg/kg/h of intravenous dexmedetomidine was administered for 10minutes, followed by a dose of 0...
May 10, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28684852/the-normal-environment-delays-the-development-of-multisensory-integration
#15
Jinghong Xu, Liping Yu, Benjamin A Rowland, Barry E Stein
Multisensory neurons in animals whose cross-modal experiences are compromised during early life fail to develop the ability to integrate information across those senses. Consequently, they lack the ability to increase the physiological salience of the events that provide the convergent cross-modal inputs. The present study demonstrates that superior colliculus (SC) neurons in animals whose visual-auditory experience is compromised early in life by noise-rearing can develop visual-auditory multisensory integration capabilities rapidly when periodically exposed to a single set of visual-auditory stimuli in a controlled laboratory paradigm...
July 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28684143/what-s-new-in-clinical-obstetric-anesthesia-in-2015
#16
REVIEW
P E Hess
Each calendar year the Society for Obstetric Anesthesia and Perinatology invites an individual to conduct a review of the medical literature, identifying clinically relevant publications of interest to the obstetric anesthesia provider. This report of that effort covers the publications from 2015 and includes the categories of anesthesia and analgesia, complications of neuraxial procedures, and the effects of anesthesia on the fetus. Neuraxial procedures represent the foundation of obstetric anesthesia; advances in anesthesia and analgesia include novel modes of administration, and refinements in care of the medically complex patient...
March 18, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28684142/neuraxial-anesthesia-in-a-patient-with-anti-n-methyl-d-aspartate-receptor-encephalitis-in-pregnancy-management-for-cesarean-delivery-and-oophorectomy
#17
L Demma, S Norris, J Dolak
We describe the neuraxial anesthetic management of a 28-year-old primigravid patient with severe, treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis undergoing cesarean delivery. The presence of an ovarian teratoma was suspected although not confirmed by imaging. The severity of symptoms, ineffective immunotherapy and the need for chemotherapy necessitated cesarean delivery and resection of a suspected teratoma at 28weeks estimated gestational age. A combined spinal-epidural technique was used...
May 11, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28684141/anaesthetic-management-of-a-patient-with-multiple-pterygium-syndrome-for-elective-caesarean-section
#18
V Daga, C Mendonca, F Choksey, J Elton, S Radhakrishna
We report a case of a pregnant woman with multiple pterygium syndrome who presented for elective caesarean section. Neuraxial anaesthesia failed and the backup plan of awake intubation was extremely difficult.
April 12, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28680735/pilocytic-astrocytoma-a-rare-presentation-as-intraventricular-tumor
#19
Sidra Sattar, Naveed Z Akhunzada, Gohar Javed, Zeeshan Uddin, Yasir A Khan
BACKGROUND: Pilocytic astrocytoma (PA) is the most prevalent central nervous system (CNS) tumor in pediatric population and accounts for an approximate of 5-6% of all gliomas. This neoplasm can occur at all levels of the neuraxis, with majority (67%) arising in the cerebellum and optic pathway. PAs are World Health Organization Grade I tumors and are the most benign of all astrocytomas characterized by an excellent prognosis. Other differentials include subependymal giant cell astrocytoma (SEGA), ependymoma, meningioma, and low-grade gliomas such as pilocytic or diffuse astrocytoma; calcification is more commonly regarded as a feature of benign or slow-growing tumors...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28680728/intradural-extramedullary-cavernous-malformation-with-extensive-superficial-siderosis-of-the-neuraxis-case-report-and-review-of-literature
#20
Pedram Golnari, Sameer A Ansari, Ali Shaibani, Michael C Hurley, Matthew B Potts, Missia E Kohler, Patrick A Sugrue, Babak S Jahromi
BACKGROUND: Spinal cavernous malformations usually affect the vertebral bodies and are seldom intradural. Here, we report a rare spinal intradural-extramedullary cavernous malformation associated with extensive superficial siderosis along the neuraxis in a patient with radicular complaints. CASE DESCRIPTION: A 60-year-old male presented with subacute headaches, intermittent fever, and acute back and radicular leg pain for 1-2 weeks. Magnetic resonance imaging revealed an intradural-extramedullary lesion just below the conus medullaris (at the L2 level)...
2017: Surgical Neurology International
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