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https://www.readbyqxmd.com/read/27918334/challenges-of-anesthesia-in-low-and-middle-income-countries-a-cross-sectional-survey-of-access-to-safe-obstetric-anesthesia-in-east-africa
#1
Isabella Epiu, Jossy Verel Bahe Tindimwebwa, Cephas Mijumbi, Thomas M Chokwe, Edwin Lugazia, Francois Ndarugirire, Theogene Twagirumugabe, Gerald Dubowitz
BACKGROUND: The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa. METHODS: A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi...
December 1, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27917348/resolution-of-constipation-anal-stricture-and-iron-deficiency-anemia-after-iron-infusion-an-analogy-with-plummer-vinson-syndrome
#2
Vijaypal Arya, Shikha Singh, Shashank Agarwal, Arjun Ohri
BACKGROUND: Anal stricture is a disabling condition which is often unresponsive to conservative medical management. The complications of surgical procedures such as dilatations and anoplasty make it a formidable treatment challenge. Through this case, we report and explore a new medical treatment for ano-rectal strictures with an analogy to Plummer Vinson syndrome. A 69-year-old male presented with chronic constipation, rectal pain, and easy fatigability. The physical exam was negative for anal fissure and a digital rectal examination could not be completed because an index finger could not be advanced through the narrowed anus...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27914160/infectious-postpartum-sacroiliitis-the-importance-and-difficulty-of-early-diagnosis
#3
Emídio Vale-Fernandes, Fedra Rodrigues, Carla Monteiro, Luís Carvalho
The sacroiliitis accounts for about 1.5% - 10% of all cases of septic arthritis and it is strongly associated with gynaecological infections, pelvic trauma or drug abuse (3.4% - 12.8% of cases occur during the postpartum period). Early diagnosis is difficult because the symptoms are nonspecific in pregnancy and in the postpartum period, making the delay of treatment a serious risk of irreversible damage to the joint and development of post-infectious complications. The authors describe the case of a 37-year-old puerperal woman presented to hospital, weeks after urgent caesarean section, with endometritis, post-anesthetic epidural hematoma and secondary infectious postpartum sacroiliitis...
August 2016: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/27906705/arterial-pressure-variation-in-elective-noncardiac-surgery-identifying-reference-distributions-and-modifying-factors
#4
Michael R Mathis, Samuel A Schechtman, Milo C Engoren, Amy M Shanks, Aleda Thompson, Sachin Kheterpal, Kevin K Tremper
BACKGROUND: Assessment of need for intravascular volume resuscitation remains challenging for anesthesiologists. Dynamic waveform indices, including systolic and pulse pressure variation, are demonstrated as reliable measures of fluid responsiveness for mechanically ventilated patients. Despite widespread use, real-world reference distributions for systolic and pulse pressure variation values have not been established for euvolemic intraoperative patients. The authors sought to establish systolic and pulse pressure variation reference distributions and assess the impact of modifying factors...
December 1, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27895942/an-unusual-lacerated-tracheal-tube-during-le-fort-surgery-literature-review-and-case-report
#5
Preeta George, John E Fiadjoe, Allan F Simpao
Maxillofacial surgeries can present unique anesthetic challenges due to potentially complex anatomy and the close proximity of the patient's airway to the surgical field. Damage to the tracheal tube (TT) during maxillofacial surgery may lead to significant airway compromise. We report the management of a patient with a partially severed TT during Le Fort surgery for midfacial hypoplasia and management strategies based on peer-reviewed literature. This case illustrates the clinical clues associated with a damaged TT and explores the challenges of managing this potentially catastrophic issue...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27889808/pharmacodynamic-evaluation-of-lys-5-meleu-9-nle-10-nka-4-10-prokinetic-effects-on-bladder-and-colon-activity-in-acute-spinal-cord-transected-and-spinally-intact-rats
#6
F Aura Kullmann, M Katofiasc, K B Thor, Lesley Marson
The purpose of this study was to determine feasibility of a novel therapeutic approach to drug-induced voiding after spinal cord injury (SCI) using a well-characterized, peptide, neurokinin 2 receptor (NK2 receptor) agonist, Lys(5), MeLeu(9), Nle(10)-NKA(4-10) (LMN-NKA). Cystometry and colorectal pressure measurements were performed in urethane-anesthetized, intact, and acutely spinalized female rats. Bladder pressure and voiding were monitored in response to intravenous LMN-NKA given with the bladder filled to 70% capacity...
November 26, 2016: Naunyn-Schmiedeberg's Archives of Pharmacology
https://www.readbyqxmd.com/read/27884666/anesthetic-considerations-in-a-parturient-with-congenital-insensitivity-to-pain-with-anhidrosis
#7
Z Pirani, F Qasem, S Katsiris
Congenital insensitivity to pain is a rare autosomal recessive disease characterized by varying degrees of autonomic dysfunction and sensory loss, including nociceptive hyposensitivity. It is this autonomic dysfunction that makes both general and neuraxial anesthesia challenging. Testing the block during neuraxial anesthesia may be difficult and the patient may be prone to hypotension and bradycardia. This case report describes the anesthetic management of a parturient with congenital insensitivity to pain presenting for cesarean delivery...
October 21, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27884218/the-current-state-of-perioperative-pain-management-challenges-and-potential-opportunities-for-nurses
#8
Melanie H Simpson, Patricia Bruckenthal
Achievement of adequate postoperative pain management is a critical challenge in health care, with an estimated three out of four adult surgical patients reporting moderate to extreme pain after surgery. Overreliance on opioids in acute care settings has persisted, despite well-known adverse side effects frequently associated with this class of drugs. Furthermore, patients with a history of chronic opioid use present additional challenges in terms of postsurgical pain management. Advances in the development of newer analgesic agents and anesthetic techniques may be useful in surgical patients with a history of chronic opioid use and in the overall surgical patient population...
December 2016: AORN Journal
https://www.readbyqxmd.com/read/27879606/improving-outcomes-in-tendon-repair-a-critical-look-at-the-evidence-for-flexor-tendon-repair-and-rehabilitation
#9
Wee S Khor, Martin F Langer, Richard Wong, Rui Zhou, Fiona Peck, Jason K F Wong
LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Appreciate the variation and evolution of flexor tendon management 2. Know how to assess the patient who presents with a flexor tendon laceration. 3. Understand the biology of repairing flexor tendon lacerations. 4. Appreciate the technical challenges in flexor tendon repair relating to different zones. 5. Understand the rationale of postoperative hand therapy. 6. Have an overview of the types of secondary tendon surgery...
December 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27873001/1-2-dimethylimidazole-4-sulfonyl-chloride-dmisc-a-novel-derivatization-strategy-for-the-analysis-of-propofol-by-lc-esi-ms-ms
#10
Alexandra Maas, Christoph Maier, Beate Michel-Lauter, Burkhard Madea, Cornelius Hess
Analysis of the anesthetic agent propofol in biological samples by LC-MS/MS is a great challenge due to weak fragmentation and poor ionization efficacy of propofol resulting in weak signal intensities. Improvements of the ionization and fragmentation efficacy can be achieved by conversion of propofol to its dimethylimidazolesulfonyl (DMIS) derivative by a derivatization reaction using 1,2-dimethylimidazole-4-sulfonyl chloride (DMISC). This DMIS derivative produced intense [M + H](+) ions in positive-ion LC-ESI-MS/MS with the dimethylimidazole moieties representing the most abundant product ions...
November 21, 2016: Analytical and Bioanalytical Chemistry
https://www.readbyqxmd.com/read/27871587/peripheral-nerve-blocks-in-the-management-of-postoperative-pain-challenges-and-opportunities
#11
REVIEW
Girish Joshi, Kishor Gandhi, Nishant Shah, Jeff Gadsden, Shelby L Corman
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871562/anesthetizing-a-child-for-a-large-compressive-mediastinal-mass-with-distraction-techniques-and-music-therapies-as-the-sole-agents
#12
Adam C Adler, Emily R Schwartz, Jennifer M Waters, Paul A Stricker
Anesthetic management of the child with an anterior mediastinal mass is challenging. The surgical/procedural goal typically is to obtain a definitive tissue diagnosis to guide treatment; the safest approach to anesthesia is often one that alters cardiorespiratory physiology the least. In severe cases, this may translate to little or no systemic sedatives/analgesics. Distraction techniques, designed to shift attention away from procedure-related pain (such as counting, listening to music, non-procedure-related talk), may be of great benefit, allowing for avoidance of pharmaceuticals...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871537/-1-8-million-and-counting-how-volatile-agent-education-has-decreased-our-spending-1000-per-day
#13
Scott A Miller, Carol A Aschenbrenner, Justin R Traunero, Loren A Bauman, Samuel S Lobell, Jeffrey S Kelly, John E Reynolds
STUDY OBJECTIVE: Volatile anesthetic agents comprise a substantial portion of every hospital's pharmacy budget. Challenged with an initiative to lower anesthetic drug expenditures, we developed an education-based intervention focused on reducing volatile anesthetic costs while preserving access to all available volatile anesthetics. When postintervention evaluation demonstrated a dramatic year-over-year reduction in volatile agent acquisition costs, we undertook a retrospective analysis of volatile anesthetic purchasing data using time series analysis to determine the impact of our educational initiative...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871527/two-lost-airways-and-one-unexpected-problem-undiagnosed-tracheal-stenosis-in-a-morbidly-obese-patient
#14
Miguel A Cobas, Nicole D Martin, Heather B Barkin
Anesthetic care of the morbidly obese is complex due to anatomic and physiologic alterations. Airway management in particular can be challenging. High body mass index is predictive of difficult ventilation and possibly difficult intubation. Other airway anomalies, such as tracheal stenosis, add to the complexity of airway management. Tracheal stenosis, a form of central airway obstruction, may be challenging to diagnose, especially in the obese. Comorbidities can mask the diagnosis and routine imaging may fail to identify the pathology...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27867865/perioperative-hemodynamic-instability-in-patients-undergoing-laparoscopic-adrenalectomy-for-pheochromocytoma
#15
REVIEW
Magdalena Pisarska, Michał Pędziwiatr, Andrzej Budzyński
Perioperative hemodynamic instability still remains the biggest surgical and anesthetic challenge in surgery for pheochromocytoma. The aim of this review was to discuss pre-, intra- and postoperative factors that may impact on hemodynamic condition of a patient. It describes patients' preparation with appropriate medication, principles of surgical technique as well as risk factors for development of hemodynamic instability in postoperative period. Currently the gold standard in the treatment of pheochromocytoma is preoperative use of alpha-blockers and laparoscopic surgery...
October 2016: Gland Surgery
https://www.readbyqxmd.com/read/27847240/inflammation-and-airway-hyperresponsiveness-after-chlorine-exposure-are-prolonged-by-nrf2-deficiency-in-mice
#16
Satoshi Ano, Alice Panariti, Benoit Allard, Michael O'Sullivan, Toby K McGovern, Yoichiro Hamamoto, Yukio Ishii, Masayuki Yamamoto, William S Powell, James G Martin
RATIONALE: Chlorine gas (Cl2) is a potent oxidant and trigger of irritant induced asthma. We explored NF-E2-related factor 2 (Nrf2)-dependent mechanisms in the asthmatic response to Cl2, using Nrf2-deficient mice, buthionine sulfoximine (BSO), an inhibitor of glutathione (GSH) synthesis and sulforaphane (SFN), a phytochemical regulator of Nrf2. METHODS: Airway inflammation and airway hyperresponsiveness (AHR) were assessed 24 and 48h after a 5-min nose-only exposure to 100ppm Cl2 of Nrf2-deficient and wild type Balb/C mice treated with BSO or SFN...
November 13, 2016: Free Radical Biology & Medicine
https://www.readbyqxmd.com/read/27833495/postoperative-pain-management-of-liver-transplantation-in-cystic-fibrosis-is-it-time-to-start-us-guided-neuraxial-blocks
#17
M Piazza, G Martucci, A Arcadipane
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27833494/anesthetic-management-of-a-case-of-sanjad-sakati-syndrome
#18
A N Alshoaiby, M Rafiq, R Jan, M Shahbaz, A Faqeeh, M A Alsohaibani
Sanjad-Sakati syndrome is an autosomal recessive genetic disorder first described in Saudi Arabia. Anesthetic management of these patients is challenging due to airway difficulties, electrolyte imbalance, growth and mental retardation, and seizures. The anesthetic management of the syndrome is described in this case report.
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27829366/anesthestic-management-of-kassabach-meritt-phenomenon-in-an-adult-case-report
#19
Abdelghafour Elkoundi, Mehdi Samali, Noureddine Kartite, Mohammed Tbouda, Mustapha Bensghir, Charki Haimeur
BACKGROUND: Kasabach-Merritt phenomenon (KMP) is characterized by a vascular tumor with profound thrombocytopenia and consumptive coagulopathy that may presents significant challenges for anesthesiologist. CASE PRESENTATION: An 87-year-old man presented with kaposiform hemangioendothelioma involving the right leg in critical condition due to massive bleeding. Hematology investigations indicated the presence of KMP. Association of this type of tumor with KMP in adults has never been reported...
November 9, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27826417/desflurane-impairs-outcome-of-organotypic-hippocampal-slices-in-an-in-vitro-model-of-traumatic-brain-injury
#20
Matthias Krings, Anke Höllig, Jingjin Liu, Linda Grüsser, Rolf Rossaint, Mark Coburn
Decreased mortality and disability after traumatic brain injury is a significant medical challenge. Desflurane, a widely used volatile anesthetic has proven to be neuroprotective in a variety of in vitro and in vivo models of ischemic brain injury. The aim of this study was to investigate whether desflurane exhibits neuroprotective properties in an in vitro model of traumatic brain injury. Organotypic hippocampal slice cultures were prepared from brains of 5-7-day-old C57/BL6 mouse pups. After 14 days of culture, the slices were subjected to a focal mechanical trauma and thereafter incubated with three different concentrations of desflurane (2, 4 and 6%) for 2, 24 and 72 hours...
March 2016: Medical Gas Research
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