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anesthesia cardiovascular regional

T Rössel, R Paul, T Richter, S Ludwig, T Hofmockel, A R Heller, T Koch
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach...
December 2016: Der Anaesthesist
Julianne Ahdout, Michael Nurok
Anesthesia and surgery in patients with hepatic and cardiac dysfunction poses a challenge for anesthesiologists. It is imperative to optimize these patients perioperatively. Cirrhosis is associated with a wide range of cardiovascular abnormalities. Cirrhotic cardiomyopathy is characterized by blunted contractile responsiveness or systolic incompetence, and/or diastolic dysfunction. In liver disease, anesthetic drug distribution, metabolism, and elimination may be altered. Among patients with liver disease, propofol is a reasonable anesthetic choice and cisatracurium is the preferred neuromuscular blocker...
December 2016: Anesthesiology Clinics
Jonatan Myrup Staalsø, Kim Zillo Rokamp, Niels D Olesen, Lars Lonn, Niels H Secher, Niels V Olsen, Teit Mantoni, Ulf Helgstrand, Henning B Nielsen
BACKGROUND: Gly16arg polymorphism of the adrenergic β2-receptor is associated with the elevated cardiac output (Q) in healthy gly16-homozygotic subjects. We questioned whether this polymorphism also affects Q and regional cerebral oxygen saturation (SCO2) during anesthesia in vascular surgical patients. METHODS: One hundred sixty-eight patients (age 71 ± 6 years) admitted for elective surgery were included. Cardiovascular variables were determined before and during anesthesia by intravascular pulse contour analysis (Nexfin) and SCO2 by cerebral oximetry (INVOS 5100C)...
December 2016: Anesthesia and Analgesia
Nurullah Yilmaz, Ersin Koksal, Gokce Ultan Ozgen, Ersan Ozen, Ahmet Dilek, Deniz Karakaya, Fatma Ulger
We consider that general anesthesia will be an appropriate and safe method as regional methods could lead to significant time loss in the prevention or minimization of complications. High blockage required for regional anesthetic methods in pregnant women with TGA and the maintenance of hemodynamic stability may become difficult due to neuroaxial sympathectomy even if a successful neuroaxial block has been provided. Agents with minimal effect on cardiovascular functions should be preferred for anesthesia induction and maintenance and close hemodynamic monitoring should be done during intraoperative and postoperative periods...
June 2016: Medical Archives
Christakis Constantinides, Kathy Murphy
To-this-date, the exact molecular, cellular, and integrative physiological mechanisms of anesthesia remain largely unknown. Published evidence indicates that anesthetic effects are multifocal and occur in a time-dependent and coordinated manner, mediated via central, local, and peripheral pathways. Their effects can be modulated by a range of variables, and their elicited end-effect on the integrative physiological response is highly variable. This review summarizes the major cellular and molecular sites of anesthetic action with a focus on the paradigm of isoflurane (ISO) - the most commonly used anesthetic nowadays - and its use in prolonged in vivo rodent studies using imaging modalities, such as magnetic resonance imaging (MRI)...
2016: Frontiers in Cardiovascular Medicine
Madhan Subramanian, Patrick J Mueller
Despite the classically held belief of an "all-or-none" activation of the sympathetic nervous system, differential responses in sympathetic nerve activity (SNA) can occur acutely at varying magnitudes and in opposing directions. Sympathetic nerves also appear to contribute differentially to various disease states including hypertension and heart failure. Previously we have reported that sedentary conditions enhanced responses of splanchnic SNA (SSNA) but not lumbar SNA (LSNA) to activation of the rostral ventrolateral medulla (RVLM) in rats...
2016: Frontiers in Physiology
José Manuel Mier-Odriozola
Non-intubated thoracic surgery entails procedures performed through regional anesthesia method in awake or mildly sedated, spontaneously ventilating patients. This method represents advantages for the cardiovascular system, and reduces the orotracheal trauma, postoperative atelectasis, and pneumonia. It also possibly reduces costs. Other theoretical advantages are: easier acceptance of surgery, attenuated stress hormone and immune response, and possibly a better survival in oncological surgery. We show a 34-year-old woman with sever palmar-axillary hyperhidrosis...
March 2016: Gaceta Médica de México
Karolina Gruca-Stryjak, Mariola Ropacka-Lesiak, Grzegorz Breborowicz
This paper presents a case of a pregnant woman with a history of two cesarean sections. The patient was admitted to the hospital because of vaginal bleeding. The ultrasound revealed a placenta covering the internal os. The placenta was characterized by heterogeneous echogenicity with visible irregular hypoechogenic areas and blurred border between the placenta and the cervix. Rich vascularity was observed on the border of the placenta, urethra and the urinary bladder. Cystoscopy showed severe congestion around the urethra...
December 2015: Ginekologia Polska
H Nilsson, U Angerås, G Sandblom, P Nordin
PURPOSE: To analyze severe complications after groin hernia repair with respect to age, ASA score, hernia anatomy, method of repair and method of anesthesia, using nationwide registers. The annual rate of 20 million groin hernia operations throughout the world renders severe complications, although rare, important both for the patient, the clinician, and the health economist. METHODS: Two nationwide registers, the Swedish Hernia Register and the National Swedish Patient Register were linked to find intraoperative complications, severe cardiovascular events and severe surgical adverse events within 30 days of groin hernia surgery...
June 2016: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Thomas Bluth, Paolo Pelosi, Marcelo Gama de Abreu
PURPOSE OF REVIEW: This article provides the reader with recent findings on the pathophysiology of comorbidities in the obese, as well as evidence-based treatment options to deal with perioperative respiratory challenges. RECENT FINDINGS: Our understanding of obesity-associated asthma, obstructive sleep apnea, and obesity hypoventilation syndrome is still expanding. Routine screening for obstructive sleep apnea using the STOP-Bang score might identify high-risk patients that benefit from perioperative continuous positive airway pressure and close postoperative monitoring...
June 2016: Current Opinion in Anaesthesiology
Steffen Rex, Sarah Devroe
PURPOSE OF REVIEW: Purpose of review is to summarize and highlight recent advances in the management of pregnant patients with pulmonary hypertension. RECENT FINDINGS: Despite recent advances in the therapy of pulmonary hypertension, prognosis for pregnant patients with pulmonary hypertension remains poor with high maternal mortality. Pregnancy is still considered contraindicated in these patients. If pregnancy occurs, referral to a tertiary hospital and a multidisciplinary approach ensure the best possible outcome...
June 2016: Current Opinion in Anaesthesiology
Joyce H Y Yeung, Simon Gates, Babu V Naidu, Matthew J A Wilson, Fang Gao Smith
BACKGROUND: Operations on structures in the chest (usually the lungs) involve cutting between the ribs (thoracotomy). Severe post-thoracotomy pain can result from pleural (lung lining) and muscular damage, costovertebral joint (ribcage) disruption and intercostal nerve (nerves that run along the ribs) damage during surgery. Poor pain relief after surgery can impede recovery and increase the risks of developing complications such as lung collapse, chest infections and blood clots due to ineffective breathing and clearing of secretions...
February 21, 2016: Cochrane Database of Systematic Reviews
Kariem El-Boghdadly, Ki Jinn Chin
PURPOSE: Regional anesthesia is enjoying a renaissance due in part to the advent of ultrasound guidance and the development of new techniques such as tissue plane blocks and local infiltration analgesia. The purpose of this Continuing Professional Development module is to provide practitioners with an understanding of the current state of knowledge surrounding local anesthetic systemic toxicity (LAST) in order to help them prevent and manage this complication more effectively. PRINCIPAL FINDINGS: The causes of LAST are multifactorial, but recognized risks include patient factors, drug doses, pharmacokinetics, and choice of regional anesthetic technique...
March 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Mehmet Taşar, Mehmet Kalender, Okay Güven Karaca, Ata Niyazi Ecevit, Salih Salihi, Taylan Adademir, Osman Tansel Darçın
BACKGROUND: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. METHODS: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively...
August 30, 2015: Heart Surgery Forum
Shawn Collins, Judy Neubrander, Zachary Vorst, Brad Sheffield
Epidural, spinal, regional, local, and intravenous administration of local anesthetics (LAs) is a cornerstone of anesthetic practice. LA toxicity is a grave consequence that is of great significance to anesthesia providers. Outcomes of LA toxicity range from inconvenient symptoms such as tinnitus, twitching, and hypotension to seizures; cardiovascular or respiratory collapse; and death. Lipid emulsion has emerged as a potential "magic bullet" in treating LA toxicity. This literature review provides background information and proposed mechanisms of action for LAs and lipid emulsion as well as animal experiments and a case report that speak to the effectiveness of lipid emulsion in the face of LA toxicity...
August 2015: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
George J Crystal, M Ramez Salem
Lower body negative pressure (LBNP) is a technique that redistributes blood from the upper body to the dependent regions of the pelvis and legs, thus reducing central venous pressure and venous return. The subject is placed in a cylindrical air-tight metal tank, which is sealed at the level of the iliac crests, and subatmospheric pressure is produced using a vacuum pump. This article reviews the historical background, physiological effects, research findings, and clinical applications of LBNP. LBNP is found in both the basic science and clinical literature, encompassing its diverse investigational and clinical applications...
April 2015: Journal of Anesthesia History
Ann-Sabin J Berli, Rahel Jud Schefer, Kathrin Steininger, Colin C Schwarzwald
BACKGROUND: Assessment of left ventricular (LV) systolic function can be achieved by conventional echocardiographic methods, but quantification of contractility, regional myocardial function, and ventricular synchrony is challenging. The goal of this study was to investigate the applicability of two-dimensional speckle tracking (2DST) to characterize segmental and global wall motion for assessment of LV function and LV synchrony in healthy goats. We aimed to describe the techniques, report normal values of a variety of 2DST indices, and determine the influence of general anesthesia...
March 17, 2015: Cardiovascular Ultrasound
Mayu Saho, Asuka Ito, Teruyuki Hiraki, Kazuo Ushijima
Trousseau's syndrome, a complex paraneoplastic disease, is characterized by the occurrence of thromboembolic disorders such as brain infarctions in patients with malignant neoplasms. We report the case of a 46-year-old woman with ovarian cancer who had suffered cerebral infarctions and presented with left hemiplegia, aphasia, and atypical genital bleeding. She suffered multiple right brain infarctions, a pulmonary embolism, a right renal infarction with bilateral hydronephrosis and deep venous thromboses and exhibited increased D-dimer and fibrinogen levels and so was administered heparin (10,000 U x day(-1))...
November 2014: Masui. the Japanese Journal of Anesthesiology
Tamara Trafidło, Tomasz Gaszyński, Wojciech Gaszyński, Katarzyna Nowakowska-Domagała
OBJECTIVES: The aim of this study is the assessment of the regional cerebral oximetry - NIRS (near infrared spectroscopy) as an intraoperative monitoring system to protect the patient against the incidents of brain desaturations. We hypothesize that patients monitored with NIRS present a smaller range of postoperative cognitive dysfunctions (POCD) in comparison with those without NIRS monitoring during lumbar spine surgery in a prone position. SETTINGS: This study was performed at the Clinical Department of Neurosurgery and Oncology of the Central Nervous System, Medical University of Lodz, Poland...
April 2015: International Journal of Surgery
Jessica Cronin, Heidi Bazick Cuschieri, Xiaobo Dong, Gretchen Oswald, Melissa Russo, Hal Dietz, Jamie Murphy
A 28-year-old primigravida female with Loeys-Dietz syndrome presented at 36 weeks' gestation for scheduled primary elective cesarean delivery. The patient had clinical findings consistent with this diagnosis, including mild aortic root dilation, chronic right vertebral artery dissection with 2 intracerebral aneurysms, and small ectasias of the thecal sac in the lumbar region. Pregnant patients with Loeys-Dietz syndrome have significant risks, including aneurysm rupture, new aneurysm formation, and uterine rupture...
February 15, 2015: A & A Case Reports
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