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131 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
J McKinlay, E Tyson, L G Forni
Peri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury...
January 2018: Anaesthesia
A-M Hristovska, P Duch, M Allingstrup, A Afshari
We compared the efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. Our outcomes were: recovery time from second twitch to train-of-four ratio > 0.9; recovery time from post-tetanic count 1-5 to train-of-four ratio > 0.9; and risk of composite adverse and serious adverse events. We searched for randomised clinical trials irrespective of publication status and date, blinding status, outcomes reported or language. We included 41 studies with 4206 participants...
December 27, 2017: Anaesthesia
Daniel I Asher, Edwin G Avery
PURPOSE OF REVIEW: Hypertension affects approximately one third of the U.S. population and is the most common preventable medical reason that surgical cases are postponed or cancelled. However, subtypes of hypertension and their perioperative risks are poorly studied and understood. We will review the natural history and pathophysiology of essential hypertension and discuss the perioperative significance of diastolic blood pressure elevation. RECENT FINDINGS: There is evidence that elevated preoperative diastolic blood pressures are associated with an increased perioperative risk of cardiovascular and cerebrovascular events and increased postoperatively 30-day mortality...
February 2018: Current Opinion in Anaesthesiology
David M Ruohoniemi, Akhilesh K Sista, Charles F Doany, Paul M Heerdt
PURPOSE OF REVIEW: Anesthesiologists are familiar with pulmonary emboli prophylaxis paradigms and many have witnessed acute intraoperative embolization. Clinicians must balance conservative anticoagulation and aggressive intervention in perioperative submassive pulmonary emboli, yet the bulk of the literature excludes surgery as a relative contraindication. This review will summarize the current treatment options for acute pulmonary emboli, drawing attention to special considerations in perioperative submassive pulmonary emboli, and discuss right ventricular monitoring to improve assessment of intervention efficacy...
February 2018: Current Opinion in Anaesthesiology
Leon Freudzon
PURPOSE OF REVIEW: Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. RECENT FINDINGS: Evidence suggests low incidence of perioperative adrenal insufficiency in patients receiving chronic glucocorticoid therapy. Recent studies show no difference in survival or hemodynamic sequella by withholding perioperative stress steroids; however, these studies are limited in size and universal applicability...
February 2018: Current Opinion in Anaesthesiology
Nikola Bradic, Zdenko Povsic-Cevra
PURPOSE OF REVIEW: The current article reviews the current evidence for continuing or discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) during the perioperative period. RECENT FINDINGS: In patients undergoing treatment of hypertension with ACEIs or ARBs, there are both benefits associated with continuing these medications during the perioperative period and higher risk for perioperative hypotension and its complications...
February 2018: Current Opinion in Anaesthesiology
Andres O Raso Vasquez, Miklos D Kertai, Manuel L Fontes
PURPOSE OF REVIEW: This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long-term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. RECENT FINDINGS: Our recent findings suggest that in some patients, the hemostatic balance during and after surgery may shift toward a hypercoagulable state and contribute to acute organ failure...
February 2018: Current Opinion in Anaesthesiology
Rakesh V Sondekoppam, Vivian Ip, David F Johnston, Vishal Uppal, Marjorie Johnson, Sugantha Ganapathy, Ban C H Tsui
BACKGROUND: The anterior iliac crest (AIC) is one of the most common sites for harvesting autologous bone, but the associated postoperative pain can result in significant morbidity. Recently, the transmuscular quadratus lumborum block (TQL) has been described to anesthetize the thoraco-lumbar nerves. This study utilizes a combination of cadaveric models and clinical case studies to evaluate the dermatomal coverage and analgesic utility of TQL for AIC bone graft donor site analgesia. METHODS: Ten ultrasound-guided TQL injections were performed in five cadaver specimens using a lateral-to-medial transmuscular approach...
November 21, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Jacob Pace, Robert Arntfield
The use of point-of-care ultrasound in trauma provides diagnostic clarity and routinely influences management. A scanning protocol known as the Focused Assessment with Sonography in Trauma (FAST) has been widely adopted by trauma providers of all specialties. The FAST exam addresses a broad array of pathologic conditions capable of causing instability, including hemoperitoneum, hemopericardium, hemothorax, and pneumothorax. The exam is an integral component to the primary assessment of injured patients and an iconic application of point-of-care ultrasound...
December 4, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Anahi Perlas, Cristian Arzola, Peter Van de Putte
This narrative review summarizes the current knowledge on point-of-care ultrasound (POCUS) of gastric contents in order to inform an assessment of aspiration risk and guide anesthetic management at the bedside. An I-AIM framework (Indication, Acquisition, Interpretation, and Medical decision-making) is used to summarize and organize the content areas. This narrative review spans the breadth of the literature on pediatric and adult subjects as well as on special patient populations such as obstetric and severely obese individuals...
April 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Simon Gelman, Luca Bigatello
PURPOSE: Understanding cardiovascular physiology should help clinicians to understand the purpose of fluid and drug management during the perioperative period. The purpose of this narrative review is to describe the pivotal role of the venous circulation in goal-directed hemodynamic and fluid therapy. SOURCE: We selected relevant literature that examines the appropriateness of fluid therapy and pharmacologic interventions during the perioperative period. PRINCIPAL FINDINGS: The interaction between the stressed and unstressed intravascular volume (Vs and Vu, respectively) regulates the venous return, which is the main determinant of cardiac output...
December 18, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Julian Aliste, Daniela Bravo, Roderick J Finlayson, De Q Tran
BACKGROUND: This randomized trial aimed to evaluate combined infraclavicular-suprascapular blocks (ICB-SSBs) as a diaphragm-sparing alternative to interscalene blocks (ISBs) for arthroscopic shoulder surgery. We hypothesized that ICB-SSB would provide equivalent postoperative analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis. METHODS: Following research ethics board approval and written informed consent, participants in the ISB group received an ultrasound-guided ISB with 20 mL of levobupivacaine 0...
December 19, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Abi Rimmer
No abstract text is available yet for this article.
December 15, 2017: BMJ: British Medical Journal
Matthew D McEvoy, Karl-Christian Thies, Sharon Einav, Kurt Ruetzler, Vivek K Moitra, Mark E Nunnally, Arna Banerjee, Guy Weinberg, Andrea Gabrielli, Gerald A Maccioli, Gregory Dobson, Michael F O'Connor
As noted in part 1 of this series, periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA...
March 2018: Anesthesia and Analgesia
Naveen Nathan
No abstract text is available yet for this article.
January 2018: Anesthesia and Analgesia
Daniel I Sessler, Steven Shafer
Clear writing makes manuscripts easier to understand. Clear writing enhances research reports, increasing clinical adoption and scientific impact. We discuss styles and organization to help junior investigators present their findings and avoid common errors.
January 2018: Anesthesia and Analgesia
T M Cook
Despite being infrequent, complications of airway management remain an important contributor to morbidity and mortality during anaesthesia and care of the critically ill. Developments in the last three decades have made anaesthesia safer, and this has been mirrored in the equipment and techniques available for airway management. Modern technology including novel oxygenation modalities, widespread availability of capnography, second-generation supraglottic airway devices and videolaryngoscopy provide the tools to make airway management safer still...
January 2018: Anaesthesia
P Van de Putte, A Perlas
No abstract text is available yet for this article.
March 2018: Anaesthesia
J A W Polderman, S C J van Steen, B Thiel, M B Godfried, P L Houweling, M W Hollmann, J H DeVries, B Preckel, J Hermanides
In this open-label multicentre randomised controlled trial, we investigated three peri-operative treatment strategies to lower glucose and reduce the need for rescue insulin in patients aged 18-75 years with type-2 diabetes mellitus undergoing non-cardiac surgery. Patients were randomly allocated using a web-based randomisation program to premedication with liraglutide (liraglutide group), glucose-insulin-potassium infusion (insulin infusion group) or insulin bolus regimen (insulin bolus group), targeting a glucose < 8...
March 2018: Anaesthesia
M El-Orbany
No abstract text is available yet for this article.
February 2018: Acta Anaesthesiologica Scandinavica
2017-12-24 09:01:21
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