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Anestesia

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85 papers 25 to 100 followers Interesting articles in adult anaesthesia from the perspective of a paediatric anaesthetist
By Ignacio Galvez Paediatric Consultant Anaesthetist with an interest in research, teaching, difficult airway and regional anaesthesia
https://www.readbyqxmd.com/read/27749350/spine-surgery-and-blood-loss-systematic-review-of-clinical-evidence
#1
Dafna Willner, Valeria Spennati, Shelly Stohl, Giulia Tosti, Simone Aloisio, Federico Bilotta
Spine surgery has been growing rapidly as a neurosurgical operation, with an increase of 220% over a 15-year period. Intraoperative blood transfusion is a major outcome determinant of spine procedures. Various approaches, including pharmacologic and nonpharmacologic therapies, have been tested to decrease both intraoperative and postoperative blood loss. The aim of this systematic review is to report clinical evidence on the relationship between intraoperative blood loss (primary outcome) and on transfusion requirements and postoperative complications (secondary outcomes) in patients undergoing spine surgery...
November 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26588483/intravenous-balanced-solutions-from-physiology-to-clinical-evidence
#2
REVIEW
Thomas Langer, Alessandro Santini, Eleonora Scotti, Niels Van Regenmortel, Manu L N G Malbrain, Pietro Caironi
"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered and supra-physiologic in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental effect on renal function associated with hyperchloremia...
2015: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27140683/stewart-acid-base-a-simplified-bedside-approach
#3
David A Story
No abstract text is available yet for this article.
August 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27195632/blood-pressure-monitoring-for-the-anesthesiologist-a-practical-review
#4
Karsten Bartels, Stephen A Esper, Robert H Thiele
Periodic, quantitative measurement of blood pressure (BP) in humans, predating the era of evidence-based medicine by over a century, is a component of the American Society of Anesthesiologists standards for basic anesthetic monitoring and is a staple of anesthetic management worldwide. Adherence to traditional BP parameters complicates the ability of investigators to determine whether particular BP ranges confer any clinical benefits. The BP waveform is a complex amalgamation of both antegrade and retrograde (reflected) pressure waves and is affected by vascular compliance, distance from the left ventricle, and the 3D structure of the vascular tree...
June 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26446688/anesthetic-considerations-in-hellp-syndrome
#5
REVIEW
M del-Rio-Vellosillo, J J Garcia-Medina
BACKGROUND: HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is an obstetric complication with heterogonous presentation and multisystemic involvement. It is characterized by microangiopathic hemolytic anemia, elevated liver enzymes by intravascular breakdown of fibrin in hepatic sinusoids and reduction of platelet circulation by its increased consumption. METHODS: In terms of these patients' anesthetic management, it is essential to consider some details: (1) effective, safe perioperative management by a multidisciplinary approach, and quick, good communication among clinical specialists to achieve correct patient management; (2) neuroaxial block, particularly spinal anesthesia, is the first choice to do the cesarean if there is only moderate, but not progressive thrombocytopenia; (3) if a general anesthesia is required, it is necessary to control the response to stress produced by intubation, especially in patients with either severe high blood pressure or neurological signs, or to prevent major cerebral complications; (4) invasive techniques, e...
February 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/26449291/obstetric-difficult-airway-guidelines-decision-making-in-critical-situations
#6
EDITORIAL
M W M Rucklidge, S M Yentis
No abstract text is available yet for this article.
November 2015: Anaesthesia
https://www.readbyqxmd.com/read/26314981/how-safe-is-deep-sedation-or-general-anesthesia-while-providing-dental-care
#7
Jeffrey D Bennett, Kyle J Kramer, Robert C Bosack
BACKGROUND: Deep sedation and general anesthesia are administered daily in dental offices, most commonly by oral and maxillofacial surgeons and dentist anesthesiologists. METHODS: The goal of deep sedation or general anesthesia is to establish a safe environment in which the patient is comfortable and cooperative. This requires meticulous care in which the practitioner balances the patient's depth of sedation and level of responsiveness while maintaining airway integrity, ventilation, and cardiovascular hemodynamics...
September 2015: Journal of the American Dental Association
https://www.readbyqxmd.com/read/26335905/noninvasive-pulse-pressure-variation-and-stroke-volume-variation-to-predict-fluid-responsiveness-at-multiple-thresholds-a-prospective-observational-study
#8
Jaap Jan Vos, Marieke Poterman, Pieternel Papineau Salm, Kai Van Amsterdam, Michel M R F Struys, Thomas W L Scheeren, Alain F Kalmar
BACKGROUND: Pulse pressure variation (PPV) and stroke volume variation (SVV) are dynamic preload variables that can be measured noninvasively to assess fluid responsiveness (FR) in anesthetized patients with mechanical ventilation. Few studies have examined the effectiveness of predicting FR according to the definition of FR, and assessment of inconclusive values of PPV and SVV around the cut-off value (the "grey zone") might improve individual FR prediction. We explored the ability of noninvasive volume clamp derived measurements of PPV and SVV to predict FR using the grey zone approach, and we assessed the influence of multiple thresholds on the predictive ability of the numerical definition of FR...
November 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/26323739/current-concepts-on-hemodynamic-support-and-therapy-in-septic-shock
#9
Leonardo Lima Rocha, Camila Menezes Souza Pessoa, Thiago Domingos Corrêa, Adriano José Pereira, Murillo Santucci Cesar de Assunção, Eliézer Silva
Severe sepsis and septic shock represent a major healthcare challenge. Much of the improvement in mortality associated with septic shock is related to early recognition combined with timely fluid resuscitation and adequate antibiotics administration. The main goals of septic shock resuscitation include intravascular replenishment, maintenance of adequate perfusion pressure and oxygen delivery to tissues. To achieve those goals, fluid responsiveness evaluation and complementary interventions - i.e. vasopressors, inotropes and blood transfusion - may be necessary...
September 2015: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/26263076/anatomy-and-pathophysiology-of-spinal-cord-injury-associated-with-regional-anesthesia-and-pain-medicine-2015-update
#10
REVIEW
Joseph M Neal, Sandra L Kopp, Jeffrey J Pasternak, William L Lanier, James P Rathmell
BACKGROUND AND OBJECTIVES: In March 2012, the American Society of Regional Anesthesia and Pain Medicine convened its second Practice Advisory on Neurological Complications in Regional Anesthesia and Pain Medicine. This update is based on the proceedings of that conference and relevant information published since its conclusion. This article updates previously described information on the pathophysiology of spinal cord injury and adds new material on spinal stenosis, blood pressure control during neuraxial blockade, neuraxial injury subsequent to transforaminal procedures, cauda equina syndrome/local anesthetic neurotoxicity/arachnoiditis, and performing regional anesthetic or pain medicine procedures in patients concomitantly receiving general anesthesia or deep sedation...
September 2015: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26258659/the-minimum-clinically-important-difference-is-fundamental-to-all-clinical-trials
#11
LETTER
Neville M Gibbs, William M Weightman
No abstract text is available yet for this article.
January 2016: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/26270569/connectivity
#12
REVIEW
Ramachandran Ramani
PURPOSE OF REVIEW: Connectivity is a technique that uses functional MRI (fMRI) to explore global brain function in healthy and diseased states. Connectivity is now being studied as a part of global brain function in major national and international studies. It is, therefore, timely to review its relevance to anaesthesia. RECENT FINDINGS: Dynamic connectivity in the brain, which transcends anatomical boundaries, links functionally related regions. Clinical manifestations in neuropsychiatric diseases such has Alzheimer's disease and schizophrenia can be explained on the basis of altered connectivity patterns in the brain...
October 2015: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/26274551/intraoperative-temperature-management-means-more-than-being-warm-at-the-end-of-the-case
#13
Jonathan P Wanderer, James P Rathmell
No abstract text is available yet for this article.
February 2015: Anesthesiology
https://www.readbyqxmd.com/read/26244287/evidence-basis-for-ultrasound-guided-block-characteristics-onset-quality-and-duration
#14
Spencer S Liu
This systematic review summarizes existing evidence for superior onset, quality, and duration of block for ultrasound guidance versus other techniques for nerve localization. MEDLINE was systematically searched from 1966 to June 2013 for randomized controlled trials (RCTs) comparing ultrasound guidance to another technique for peripheral nerve blocks. Twenty-three RCTs were identified for upper-extremity peripheral nerve blocks and 17 for lower extremity. Jadad scores for quality of RCT ranged from 1 to 5 with a median of 3...
March 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26045965/mechanical-ventilation-of-acute-respiratory-distress-syndrome
#15
REVIEW
Ryoichi Ochiai
Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, but its mortality is still as high as 30-40 %. For the last 20 years, lung protective strategy has become a standard care for ARDS, but we still do not know the best way to ventilate patients with ARDS. Tidal volume itself does not seem to have an important role to develop ventilator-induced lung injury (VILI), but the driving pressure, which is inspiratory plateau pressure-PEEP, is the most important to predict and affect the outcome of ARDS, though there is no safe limit for the driving pressure...
2015: Journal of Intensive Care
https://www.readbyqxmd.com/read/26192743/comparison-of-vivasight-double-lumen-tube-with-a-conventional-double-lumen-tube-in-adult-patients-undergoing-video-assisted-thoracoscopic-surgery
#16
COMPARATIVE STUDY
D Levy-Faber, Y Malyanker, R-R Nir, L A Best, M Barak
The efficiency of a double-lumen tube depends on its position in the airways, which can be verified by fibreoptic bronchoscopy. The VivaSight DL is a single-use double-lumen tube with a camera embedded in the tube's right side. The view from the camera appears continuously on a monitor. In this prospective study of 71 adult patients, we compared intubation times using either the VivaSight DL or a conventional double-lumen tube. Median (IQR [range]) duration of intubation with visual confirmation of tube position was significantly reduced using the VivaSight DL compared with the conventional double-lumen tube (51 (42-60 [35-118]) s vs 264 (233-325 [160-490]) s, respectively, p < 0...
November 2015: Anaesthesia
https://www.readbyqxmd.com/read/26115188/regional-anesthesia-in-patients-with-preexisting-neurologic-disease
#17
REVIEW
Sandra L Kopp, Adam K Jacob, James R Hebl
Since publication of initial recommendations in 2008, there is limited new information regarding the performance of regional anesthesia in patients with preexisting neurologic diseases. However, the strength of evidence has increased since 2008 regarding (1) the concern that diabetic nerves are more sensitive to local anesthetics and perhaps more susceptible to injury and (2) the concern that performing neuraxial anesthesia and analgesia in patients with preexisting spinal canal pathology may increase the risk of new or worsening neurologic symptoms...
September 2015: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26170349/use-of-vertebral-body-units-to-locate-the-cavoatrial-junction-for-optimum-central-venous-catheter-tip-positioning
#18
Y G Song, J H Byun, S Y Hwang, C W Kim, S G Shim
BACKGROUND: Central venous catheter (CVC) placement plays an important role in clinical practice; however, optimal positioning of the CVC tip remains a controversial issue. The objective of this study was to evaluate the use of vertebral body unit (VBUs), to locate the cavoatrial junction (CAJ), for optimal CVC tip placement based on chest radiography (CXR) using the carina as a landmark. METHODS: 524 patients who underwent coronary computed tomographic angiography (CTA) and CXR were included...
August 2015: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26170360/the-obstetric-rapid-sequence-induction-time-for-a-change
#19
LETTER
L S Nasser, S Babatunde
No abstract text is available yet for this article.
August 2015: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26087274/novel-neuromuscular-blocking-drugs-and-antagonists
#20
REVIEW
Paul M Heerdt, Hiroshi Sunaga, John J Savarese
PURPOSE OF REVIEW: This review summarizes recent progress in the development of new muscle relaxants that are inactivated by cysteine, and considers the evolving paradigm of selective relaxant binding or degrading agents that can reverse neuromuscular blockade at any time. RECENT FINDINGS: The benzylisoquinoline compound gantacurium is a nondepolarizing muscle relaxant with an ultrashort duration largely determined by the rapid rate at which endogenous L-cysteine binds to, and permanently inactivates, the molecule...
August 2015: Current Opinion in Anaesthesiology
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