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Anesthesia issues

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117 papers 1000+ followers
By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
https://www.readbyqxmd.com/read/29071382/hydroxyethyl-starch-130-0-4-versus-crystalloid-co-loading-during-general-anesthesia-induction-a-randomized-controlled-trial
#1
RANDOMIZED CONTROLLED TRIAL
Takashi Juri, Koichi Suehiro, Shigemune Kuwata, Sayaka Tsujimoto, Akira Mukai, Katsuaki Tanaka, Tokuhiro Yamada, Takashi Mori, Kiyonobu Nishikawa
PURPOSE: Hypotension and decreased cardiac output (CO) are common adverse effects during anesthesia induction depending on the patient's pre-anesthetic cardiac condition. The aim of this study was to assess the ability of hydroxyethyl starch (HES) 130/0.4 to prevent hypotension and decreased CO during the induction of general anesthesia. METHODS: Ninety patients undergoing laparoscopic surgery were randomly divided into a HES group and a crystalloid group. Following the insertion of an intravenous line, fluid was administered to each patient at a rate of 25 ml/min using either crystalloid or HES 130/0...
December 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/29223694/atraumatic-versus-conventional-lumbar-puncture-needles-a-systematic-review-and-meta-analysis
#2
Siddharth Nath, Alex Koziarz, Jetan H Badhiwala, Waleed Alhazzani, Roman Jaeschke, Sunjay Sharma, Laura Banfield, Ashkan Shoamanesh, Sheila Singh, Farshad Nassiri, Wieslaw Oczkowski, Emilie Belley-Côté, Ray Truant, Kesava Reddy, Maureen O Meade, Forough Farrokhyar, Malgorzata M Bala, Fayez Alshamsi, Mette Krag, Itziar Etxeandia-Ikobaltzeta, Regina Kunz, Osamu Nishida, Charles Matouk, Magdy Selim, Andrew Rhodes, Gregory Hawryluk, Saleh A Almenawer
BACKGROUND: Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. METHODS: In this systematic review and meta-analysis, we independently searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomised controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication...
March 24, 2018: Lancet
https://www.readbyqxmd.com/read/26727925/management-of-lumbar-spinal-stenosis
#3
REVIEW
Jon Lurie, Christy Tomkins-Lane
Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency...
January 4, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27008296/epidural-injections-for-lumbar-radiculopathy-and-spinal-stenosis-a-comparative-systematic-review-and-meta-analysis
#4
REVIEW
Laxmaiah Manchikanti, Nebojsa Nick Knezevic, Mark V Boswell, Alan D Kaye, Joshua A Hirsch
BACKGROUND: The prevalence of chronic low back pain and related disability is rapidly increasing as are the myriad treatments, including epidural injections. Even though epidural injections are one of the most commonly performed procedures in managing low back and lower extremity pain, starting in 1901 with local anesthetic alone, conflicting recommendations have been provided, despite the extensive literature. Recently Chou et al performed a technology assessment review for Agency for Healthcare Research and Quality (AHRQ) part of which was published in Annals of Internal Medicine showing lack of effectiveness of epidural steroid injections in managing lumbar radiculopathy and spinal stenosis...
March 2016: Pain Physician
https://www.readbyqxmd.com/read/16030082/a-multicentre-randomized-controlled-trial-of-epidural-corticosteroid-injections-for-sciatica-the-west-study
#5
RANDOMIZED CONTROLLED TRIAL
N K Arden, C Price, I Reading, J Stubbing, J Hazelgrove, C Dunne, M Michel, P Rogers, C Cooper
OBJECTIVE: To determine the effectiveness and predictors of response to lumbar epidural corticosteroid injections (ESI) in patients with sciatica. We performed a 12-month, multicentre, double-blind, randomized, placebo-controlled, parallel-group trial in four secondary pain-care clinics in the Wessex Region. METHODS: Two hundred and twenty-eight patients with a clinical diagnosis of unilateral sciatica of 1-18 months' duration were randomized to either three lumbar ESIs of triamcinolone acetonide or interligamentous saline injections at intervals of 3 weeks...
November 2005: Rheumatology
https://www.readbyqxmd.com/read/26715572/safety-of-epidural-corticosteroid-injections
#6
REVIEW
Ippokratis Pountos, Michalis Panteli, Gavin Walters, Dudley Bush, Peter V Giannoudis
BACKGROUND AND OBJECTIVE: Epidural corticosteroid injections (ESIs) have been used for several decades and now represent the most common intervention performed for the management of back pain with a radicular component. However, several reports have presented devastating complications and adverse effects, which fuelled concerns over the risk versus clinical effectiveness. The authors offer a comprehensive review of the available literature and analyse the data derived from studies and case reports...
March 2016: Drugs in R&D
https://www.readbyqxmd.com/read/27105466/patient-priority-weighting-of-the-roland-morris-disability-questionnaire-does-not-change-results-of-the-lumbar-epidural-steroid-injections-for-spinal-stenosis-trial
#7
RANDOMIZED CONTROLLED TRIAL
Una E Makris, Todd C Edwards, Danielle C Lavallee, Zoya Bauer, Bryan A Comstock, Jeffrey G Jarvik, Donald L Patrick, Mahshid Lotfi, Janna L Friedly
STUDY DESIGN: Secondary analysis of lumbar epidural steroid injections for spinal stenosis randomized controlled trial data. OBJECTIVE: To reevaluate whether outcomes for older adults receiving epidural steroid injections with or without corticosteroid improve after using patient-prioritized Roland-Morris Disability Questionnaire (RDQ) items. SUMMARY OF BACKGROUND DATA: Epidural corticosteroid injections are commonly used to treat lumbar spinal stenosis symptoms, despite limited evidence for their effectiveness in clinical trials...
January 1, 2017: Spine
https://www.readbyqxmd.com/read/24850120/the-potential-contributing-effect-of-ketorolac-and-fluoxetine-to-a-spinal-epidural-hematoma-following-a-cervical-interlaminar-epidural-steroid-injection-a-case-report-and-narrative-review
#8
George C Chang Chien, Zack McCormick, Marco Araujo, Kenneth D Candido
Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia...
May 2014: Pain Physician
https://www.readbyqxmd.com/read/26610278/is-epidural-steroid-injection-effective-for-degenerative-lumbar-spinal-stenosis
#9
Sebastián Flores, Marcelo Molina
There are several nonsurgical alternatives to treat radicular pain in degenerative lumbar spinal stenosis. Epidural steroid injections have been used for several decades, but the different studies have shown variable effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified nine systematic reviews including seven pertinent randomized controlled trials. We concluded epidural steroid injection probably leads to little or no effect on reducing radicular pain of spinal stenosis...
November 16, 2015: Medwave
https://www.readbyqxmd.com/read/26475800/aspirin-and-spinal-haematoma-after-neuraxial-anaesthesia-myth-or-reality
#10
REVIEW
R S Vela Vásquez, R Peláez Romero
The safety of aspirin therapy in neuraxial anaesthesia has been historically questioned, and the current recommendations are still heterogeneous. A comprehensive review of clinical evidence and a comparative analysis of European and American guidelines were performed. Low-dose aspirin produces a selective, complete and irreversible cyclooxygenase-1 blockade, and higher doses do not increase the antiplatelet effect. Additional cyclooxygenase-2 blockade by high-dose aspirin might decrease the antithrombotic efficacy by inhibiting endothelial prostacyclin synthesis...
November 2015: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28364145/deep-anesthesia-too-much-of-a-good-thing
#11
EDITORIAL
Matthew T V Chan, Mandy H M Chu, Carmen K M Lam, Bo Jia, Sharon Tsang, William K K Wu
No abstract text is available yet for this article.
June 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28184264/heated-carrier-fluids-in-decreasing-propofol-injection-pain-a-randomized-controlled-trial
#12
Ann Misun Youn, Tzung-Min Hsu
BACKGROUND: Propofol is a commonly used intravenous drug during anesthetic induction because of its rapid onset and short duration. However, the injection pain that patients experience is so severe that they recall the induction of anesthesia as the most painful part of the perioperative period. Therefore, the objective of this study was to determine the effect of heated carrier fluids (40℃) in decreasing propofol injection pain. METHODS: A randomized, controlled clinical trial was conducted in 90 patients aged 18 to 65 who were scheduled for either elective or urgent surgery under general anesthesia classified as American Society of Anesthesiologists physical status I or II...
February 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/21596885/gastric-sonography-in-the-fasted-surgical-patient-a-prospective-descriptive-study
#13
COMPARATIVE STUDY
Anahi Perlas, Liisa Davis, Masood Khan, Nicholas Mitsakakis, Vincent W S Chan
BACKGROUND: Aspiration pneumonia remains a serious anesthetic-related complication. A reliable diagnostic tool to assess gastric volume is currently lacking. We recently demonstrated that gastric sonography can provide reliable qualitative and quantitative information about gastric content and volume in healthy volunteers. In the current study, we performed a prospective qualitative and quantitative analysis of the gastric antrum in 200 fasted patients undergoing elective surgery. METHODS: A standardized gastric scanning protocol was applied before anesthetic induction...
July 2011: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27440628/preoperative-heart-rate-and-myocardial-injury-after-non-cardiac-surgery-results-of-a-predefined-secondary-analysis-of-the-vision-study
#14
MULTICENTER STUDY
T E F Abbott, G L Ackland, R A Archbold, A Wragg, E Kam, T Ahmad, A W Khan, E Niebrzegowska, R N Rodseth, P J Devereaux, R M Pearse
BACKGROUND: Increased baseline heart rate is associated with cardiovascular risk and all-cause mortality in the general population. We hypothesized that elevated preoperative heart rate increases the risk of myocardial injury after non-cardiac surgery (MINS). METHODS: We performed a secondary analysis of a prospective international cohort study of patients aged ≥45 yr undergoing non-cardiac surgery. Preoperative heart rate was defined as the last measurement before induction of anaesthesia...
August 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27140683/stewart-acid-base-a-simplified-bedside-approach
#15
David A Story
No abstract text is available yet for this article.
August 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27465522/current-evidence-is-not-in-support-of-lipid-rescue-therapy-in-local-anaesthetic-systemic-toxicity
#16
EDITORIAL
P H Rosenberg
No abstract text is available yet for this article.
September 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27087980/fluid-therapy-in-the-perioperative-setting-a-clinical-review
#17
REVIEW
Anders Winther Voldby, Birgitte Brandstrup
BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/26997303/the-impact-of-preoperative-corticosteroids-on-the-systemic-inflammatory-response-and-postoperative-complications-following-surgery-for-gastrointestinal-cancer-a-systematic-review-and-meta-analysis
#18
REVIEW
Stephen T McSorley, Paul G Horgan, Donald C McMillan
BACKGROUND: This meta-analysis examined the impact of preoperative corticosteroids on interleukin 6 (IL-6), C-reactive protein (CRP), and complications following surgery for gastrointestinal cancer. METHODS: A systematic review was performed using appropriate keywords. Random-effects meta-analysis was performed. RESULTS: 11 RCTs with 474 patients, were included. Corticosteroids were significantly associated with lower IL-6 on postoperative day 1 (mean difference -148pg/mL, 95% CI -205 to -92, p<0...
May 2016: Critical Reviews in Oncology/hematology
https://www.readbyqxmd.com/read/20052816/regional-anesthesia-in-the-patient-receiving-antithrombotic-or-thrombolytic-therapy-american-society-of-regional-anesthesia-and-pain-medicine-evidence-based-guidelines-third-edition
#19
Terese T Horlocker, Denise J Wedel, John C Rowlingson, F Kayser Enneking, Sandra L Kopp, Honorio T Benzon, David L Brown, John A Heit, Michael F Mulroy, Richard W Rosenquist, Michael Tryba, Chun-Su Yuan
The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown. Although the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics, recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient populations.Overall, the risk of clinically significant bleeding increase with age,associated abnormalities of the spinal cord or vertebral column, the presence of an underlying coagulopathy, difficulty during needle placement,and an indwelling neuraxial catheter during sustained anticoagulation( particularly with standard heparin or low-molecular weight heparin)...
January 2010: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26858095/what-works-and-what-s-safe-in-pediatric-emergency-procedural-sedation-an-overview-of-reviews
#20
REVIEW
Lisa Hartling, Andrea Milne, Michelle Foisy, Eddy S Lang, Douglas Sinclair, Terry P Klassen, Lisa Evered
BACKGROUND: Sedation is increasingly used to facilitate procedures on children in emergency departments (EDs). This overview of systematic reviews (SRs) examines the safety and efficacy of sedative agents commonly used for procedural sedation in children in the ED or similar settings. METHODS: We followed standard SR methods: comprehensive search; dual study selection, quality assessment, data extraction. We included SRs of children (1 month to 18 years) where the indication for sedation was procedure-related and performed in the ED...
May 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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