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https://www.readbyqxmd.com/read/28212182/what-s-new-in-obstetric-anesthesia-the-2016-gerard-w-ostheimer-lecture
#1
Philip E Hess
This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories. Cardiovascular and noncardiovascular medical diseases now account for half of maternal deaths in the United States...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28212172/cognitive-decline-associated-with-anesthesia-and-surgery-in-the-elderly-does-this-contribute-to-dementia-prevalence
#2
Lisbeth Evered, David A Scott, Brendan Silbert
PURPOSE OF REVIEW: To provide an update on the current state of research investigating the effects of anesthesia and surgery on cognition in the elderly, including consideration of overlap with cognitive disorders in the community. RECENT FINDINGS: The studies reviewed here identify detrimental effects of anesthesia and surgery on cognition in a proportion of elderly individuals. Animal models demonstrate an association between anesthetic agents and Alzheimer's disease pathology...
February 15, 2017: Current Opinion in Psychiatry
https://www.readbyqxmd.com/read/28211140/anesthesia-for-fetal-surgery
#3
REVIEW
Monica A Hoagland, Debnath Chatterjee
Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. The potential for maternal morbidity is significant and must be carefully weighed against claimed benefits to the fetus. Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended...
February 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28210760/-risk-management-in-anesthesia-and-critical-care-medicine
#4
C Eisold, A R Heller
Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture...
February 16, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28194399/the-role-of-permissive-and-induced-hypotension-in-current-neuroanesthesia-practice
#5
Suren Soghomonyan, Nicoleta Stoicea, Gurneet S Sandhu, Jeffrey J Pasternak, Sergio D Bergese
BACKGROUND: Induced hypotension (IH) had been used for decades in neurosurgery to reduce the risk for intraoperative blood loss and decrease blood replacement. More recently, this method fell out of favor because of concerns for cerebral and other end-organ ischemia and worse treatment outcomes. Other contributing factors to the decline in its popularity include improvements in microsurgical technique, widespread use of endovascular procedures, and advances in blood conservation and transfusion protocols...
2017: Frontiers in Surgery
https://www.readbyqxmd.com/read/28187805/the-history-of-neurocritical-care
#6
E F M Wijdicks
Critical care medicine came into sharp focus in the second part of the 20th century. The care of acutely ill neurologic patients in the USA may have originated in postoperative neurosurgical units, but for many years patients with neurocritical illness were admitted to intensive care units next to patients with general medical or surgical conditions. Neurologists may have had their first exposure to the complexity of neurocritical care during the poliomyelitis epidemics, but few were interested. Much later, the development of neurocritical care as a legitimate subspecialty was possible as a result of a new cadre of neurologists, with support by departments of neurosurgery and anesthesia, who appreciated their added knowledge and expertise in care of acute neurologic illness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28125532/the-modern-male-rhytidectomy-lessons-learned
#7
Rod J Rohrich, James M Stuzin, Smita Ramanadham, Christopher Costa, Phillip B Dauwe
BACKGROUND: Cosmetic surgery among male patients has become increasingly popular. The face-lift technique is different in male patients, specifically regarding preservation of hair follicles, restoration of a youthful and well appearance, and reduction of the risk of hematoma. METHODS: A retrospective review of a single surgeon's past 20 years of consecutive male rhytidectomies revealed a cohort of 83 patients. A control group was created by random selection of 83 age-matched female rhytidectomy patients during the same period...
February 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28079584/the-development-and-implementation-of-cognitive-aids-for-critical-events-in-pediatric-anesthesia-the-society-for-pediatric-anesthesia-critical-events-checklists
#8
Anna Clebone, Barbara K Burian, Scott C Watkins, Jorge A Gálvez, Justin L Lockman, Eugenie S Heitmiller
Cognitive aids such as checklists are commonly used in modern operating rooms for routine processes, and the use of such aids may be even more important during critical events. The Quality and Safety Committee of the Society for Pediatric Anesthesia (SPA) has developed a set of critical-event checklists and cognitive aids designed for 3 purposes: (1) as a repository of the latest evidence-based and expert opinion-based information to guide response and management of critical events, (2) as a source of just-in-time information during critical events, and (3) as a method to facilitate a shared understanding of required actions among team members during a critical event...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28047720/su-f-t-633-cyberknife-boost-versus-conventional-tandem-and-ovoid-treatment-for-cervical-cancer
#9
J Santoro, M Witten, J Haas
PURPOSE: Brachytherapy has been the standard of care for cervical cancer for 100 years. The treatment can be administered using an HDR (high dose rate) remote afterloader with a (192) Ir source in an outpatient setting, a PDR afterloader with a (192) Ir source, or with LDR manually loaded or a remote afterloader utilizing (192) Ir or (137) Cs sources in an inpatient setting. The procedure involves the placement of a tandem and ovoid, tandem and ring, or tandem and cylinder applicator in an operating room setting with the patient under general anesthesia...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28031981/drug-delivery-biomaterials-and-nanomedicine-an-interview-with-daniel-s-kohane
#10
Daniel S Kohane
Daniel Kohane speaks to Francesca Lake, Managing Editor: Obtaining his MD and PhD in Physiology from Boston University (MA, USA), Dan Kohane went on to complete residencies in Pediatrics at Boston Children's Hospital (MA, USA) and Anesthesiology at Massachusetts General Hospital (USA), followed by a fellowship in Pediatric Critical Care at Boston Children's Hospital. He is currently a Professor of Anesthesia at Harvard Medical School (MA, USA) and a Senior Associate in Pediatric Critical Care at Boston Children's Hospital, where he directs the Laboratory for Biomaterials and Drug Delivery...
September 2016: Future Science OA
https://www.readbyqxmd.com/read/28011033/cost-savings-and-patient-experiences-of-a-clinic-based-wide-awake-hand-surgery-program-at-a-military-medical-center-a-critical-analysis-of-the-first-100-procedures
#11
Peter C Rhee, Michelle M Fischer, Laura S Rhee, Ha McMillan, Anthony E Johnson
PURPOSE: Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. METHODS: A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon...
December 20, 2016: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28004329/validation-of-the-glycemic-stress-index-in-pediatric-neurosurgical-intensive-care
#12
Marco Piastra, Alessandro Pizza, Federica Tosi, Sonia Mensi, Luca Massimi, Andrea De Bellis, Daniele G Biasucci, Ersilia Luca, Giorgio Conti, Daniele De Luca
BACKGROUND: Studies have suggested that both the degree and the duration of hyperglycemia are independent risk factors for adverse outcome both in pediatric anesthesia and in critically ill children. In a recent paper, we combined intraoperative glycemic variations and length of surgery creating a metabolic glucose-related stress index called "Glycemic Stress Index" (GSI). AIM: To validate GSI for predicting PICU stay in a population of children undergoing different major neurosurgical procedures...
December 21, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/28002714/hypothermia-for-neuroprotection-in-convulsive-status-epilepticus
#13
RANDOMIZED CONTROLLED TRIAL
Stephane Legriel, Virginie Lemiale, Maleka Schenck, Jonathan Chelly, Virginie Laurent, Fabrice Daviaud, Mohamed Srairi, Aicha Hamdi, Guillaume Geri, Thomas Rossignol, Julia Hilly-Ginoux, Julie Boisramé-Helms, Benjamin Louart, Isabelle Malissin, Nicolas Mongardon, Benjamin Planquette, Marina Thirion, Sybille Merceron, Emmanuel Canet, Fernando Pico, Yves-Roger Tran-Dinh, Jean-Pierre Bedos, Elie Azoulay, Matthieu Resche-Rigon, Alain Cariou
Background Convulsive status epilepticus often results in permanent neurologic impairment. We evaluated the effect of induced hypothermia on neurologic outcomes in patients with convulsive status epilepticus. Methods In a multicenter trial, we randomly assigned 270 critically ill patients with convulsive status epilepticus who were receiving mechanical ventilation to hypothermia (32 to 34°C for 24 hours) in addition to standard care or to standard care alone; 268 patients were included in the analysis. The primary outcome was a good functional outcome at 90 days, defined as a Glasgow Outcome Scale (GOS) score of 5 (range, 1 to 5, with 1 representing death and 5 representing no or minimal neurologic deficit)...
22, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27989360/complications-in-neonatal-surgery
#14
Mauricio A Escobar, Michael G Caty
Neonatal surgery is recognized as an independent discipline in general surgery, requiring the expertise of pediatric surgeons to optimize outcomes in infants with surgical conditions. Survival following neonatal surgery has improved dramatically in the past 60 years. Improvements in pediatric surgical outcomes are in part attributable to improved understanding of neonatal physiology, specialized pediatric anesthesia, neonatal critical care including sophisticated cardiopulmonary support, utilization of parenteral nutrition and adjustments in fluid management, refinement of surgical technique, and advances in surgical technology including minimally invasive options...
December 2016: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/27984246/the-hypothalamic-pituitary-adrenal-axis-and-anesthetics-a-review
#15
Emmanuel Besnier, Thomas Clavier, Vincent Compere
The hypothalamic-pituitary-adrenal (HPA) axis is essential for human adaptation to stress. However, many anesthetic agents may interfere with the activity of this axis. Although etomidate is known for its suppressive effect on HPA axis function, in vitro evidence suggests that many other drugs used in anesthesia care may also interfere with HPA activity. In this review, we discuss the mechanisms by which all HPA axis activity may be altered during anesthesia and critical care and focus on the impact of hypnotic and analgesic drugs...
December 14, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27975008/successful-treatment-of-pyoderma-gangrenosum-after-augmentation-mastopexy-using-vacuum-therapy
#16
Julio Alberto Soncini, Alessandra Grassi Salles, Juvenal Antonio Frizzo Neto, Rolf Gemperli
BACKGROUND: Pyoderma gangrenosum (PG) is a rare, severe, destructive neutrophilic dermatosis characterized by a progressive, necrotizing process after skin injury. Its cause is still unknown, and diagnosis represents a challenge when ulcers are seen after surgery. Bacterial infection is not found in the wounds. Patients exhibit "pathergy" with the appearance of new lesions after local trauma such as surgical procedures, debridements, and wound care, suggesting altered inflammatory response...
November 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/27966337/the-incidence-of-pressure-ulcer-in-patients-on-mechanical-ventilation-andeffects-of-selected-risk-factors-on-pressure-ulcer-development
#17
Özgül Karayurt, Özay Akyol, Necmiye Kılıçaslan, Nuray Akgün, Ümran Sargın, Melike Kondakçı, Hanım Ekinci, Neslihan Sarı
BACKGROUND/AIM: This study aimed to determine the incidence of pressure ulcers in patients on mechanical ventilation and selected risk factors likely to play a role in pressure ulcer development. MATERIALS AND METHODS: The study included 110 patients recruited from an anesthesia critical care unit of a university hospital. Data were collected with a demographic and clinical characteristics form. The form was composed of questions about demographic characteristics and clinical features including diagnosis, duration of mechanical ventilation, general well-being, oxygenation, perfusion, and skin condition...
November 17, 2016: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/27965560/ketamine-50-years-of-modulating-the-mind
#18
REVIEW
Linda Li, Phillip E Vlisides
Ketamine was introduced into clinical practice in the 1960s and continues to be both clinically useful and scientifically fascinating. With considerably diverse molecular targets and neurophysiological properties, ketamine's effects on the central nervous system remain incompletely understood. Investigators have leveraged the unique characteristics of ketamine to explore the invariant, fundamental mechanisms of anesthetic action. Emerging evidence indicates that ketamine-mediated anesthesia may occur via disruption of corticocortical information transfer in a frontal-to-parietal ("top down") distribution...
2016: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/27902826/association-of-a-frailty-screening-initiative-with-postoperative-survival-at-30-180-and-365-days
#19
Daniel E Hall, Shipra Arya, Kendra K Schmid, Mark A Carlson, Pierre Lavedan, Travis L Bailey, Georgia Purviance, Tammy Bockman, Thomas G Lynch, Jason M Johanning
Importance: As the US population ages, the number of operations performed on elderly patients will likely increase. Frailty predicts postoperative mortality and morbidity more than age alone, thus presenting opportunities to identify the highest-risk surgical patients and improve their outcomes. Objective: To examine the effect of the Frailty Screening Initiative (FSI) on mortality and complications by comparing the surgical outcomes of a cohort of surgical patients treated before and after implementation of the FSI...
November 30, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27901299/first-steps-in-validating-the-pediatric-anesthesia-parent-satisfaction-paps-survey
#20
Sarah J Milliken-Glabe, Jeannie Zuk, Sonja I Ziniel, Kara A Bjur, Monica Alvarez, Judit M Szolnoki, Norah R Janosy
BACKGROUND: In the last few decades, patient satisfaction has become a critical component of quality assessment and is being incorporated into payment for performance plans. However, assessment of satisfaction with anesthesia services is problematic and few validated satisfaction tools have been published. Assessing parent satisfaction with pediatric anesthesia services is even more challenging. OBJECTIVE: Our aim was to develop, implement, and start validating a set of survey questions that evaluate parental satisfaction with the pediatric anesthesia services in order to identify strengths and potential areas for improvement...
February 2017: Paediatric Anaesthesia
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