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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
B Doleman, T P Heinink, D J Read, R J Faleiro, J N Lund, J P Williams
We searched MEDLINE, Embase, CINAHL, AMED and CENTRAL databases until December 2014 and included 133 randomised controlled trials of peri-operative gabapentin vs placebo. Gabapentin reduced mean (95% CI) 24-h morphine-equivalent consumption by 8.44 (7.26-9.62) mg, p < 0.001, whereas more specific reductions in morphine equivalents were predicted (R(2)  = 90%, p < 0.001) by the meta-regression equation: 3.73 + (-0.378 × control morphine consumption (mg)) + (-0.0023 × gabapentin dose (mg)) + (-1...
October 2015: Anaesthesia
Karen K Lam, Samuel Kunder, Jean Wong, Anthony G Doufas, Frances Chung
PURPOSE OF REVIEW: Perioperative opioid-based pain management of patients suffering from obstructive sleep apnea (OSA) may present challenges because of concerns over severe ventilatory compromise. The interaction between intermittent hypoxia, sleep fragmentation, pain, and opioid responses in OSA, is complex and warrants a special focus of perioperative outcomes research. RECENT FINDINGS: Life-threatening opioid-related respiratory events are rare. Epidemiologic evidence suggests that OSA together with other serious renal and heart disease, is among those conditions predisposing patients for opioid-induced ventilatory impairment (OIVI) in the postoperative period...
February 2016: Current Opinion in Anaesthesiology
Mitchell H Katz
No abstract text is available yet for this article.
May 1, 2016: JAMA Internal Medicine
Mengzhu Li, Shuqing Jin, Xiang Zhao, Zhendong Xu, Xiu Ni, Lingling Zhang, Zhiqiang Liu
OBJECTIVES: The purpose of this study was to investigate the efficacy and safety of magnesium sulfate as an adjuvant of local anesthetics in perineural nerve blocks. MATERIALS AND METHODS: Randomized controlled trials studying the effect and safety of magnesium sulfate in perineural nerve blocks were retrieved from online databases. The mean difference (MD), risk ratio, and their corresponding 95% confidence intervals (CIs) were calculated using RevMan 5.3 statistical software...
February 17, 2016: Clinical Journal of Pain
Joyce H Y Yeung, Simon Gates, Babu V Naidu, Matthew J A Wilson, Fang Gao Smith
BACKGROUND: Operations on structures in the chest (usually the lungs) involve cutting between the ribs (thoracotomy). Severe post-thoracotomy pain can result from pleural (lung lining) and muscular damage, costovertebral joint (ribcage) disruption and intercostal nerve (nerves that run along the ribs) damage during surgery. Poor pain relief after surgery can impede recovery and increase the risks of developing complications such as lung collapse, chest infections and blood clots due to ineffective breathing and clearing of secretions...
2016: Cochrane Database of Systematic Reviews
Thomas G Brott, George Howard, Gary S Roubin, James F Meschia, Ariane Mackey, William Brooks, Wesley S Moore, Michael D Hill, Vito A Mantese, Wayne M Clark, Carlos H Timaran, Donald Heck, Pierre P Leimgruber, Alice J Sheffet, Virginia J Howard, Seemant Chaturvedi, Brajesh K Lal, Jenifer H Voeks, Robert W Hobson
BACKGROUND: In the Carotid Revascularization Endarterectomy versus Stenting Trial, we found no significant difference between the stenting group and the endarterectomy group with respect to the primary composite end point of stroke, myocardial infarction, or death during the periprocedural period or any subsequent ipsilateral stroke during 4 years of follow-up. We now extend the results to 10 years. METHODS: Among patients with carotid-artery stenosis who had been randomly assigned to stenting or endarterectomy, we evaluated outcomes every 6 months for up to 10 years at 117 centers...
March 17, 2016: New England Journal of Medicine
J David Spence, A Ross Naylor
No abstract text is available yet for this article.
March 17, 2016: New England Journal of Medicine
Asad E Patanwala, Jennifer R Martin, Brian L Erstad
OBJECTIVE: To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit. METHODS: MEDLINE and EMBASE were queried from inception until July 2015. Search terms used included ketamine, intensive care, and critical care. The search retrieved 584 articles to be screened for inclusion. The intent was to include randomized controlled studies using sustained intravenous infusions (>24 hours) of ketamine in the critically ill patients...
December 8, 2015: Journal of Intensive Care Medicine
O Goren, I Matot
Perioperative acute kidney injury (AKI) is not uncommon and is associated with considerable morbidity and mortality. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Novel biomarkers are under investigation as fast and accurate predictors of AKI. Several special considerations regarding the risk of AKI are of note in the surgical patient. Co-morbidities are important risk factors for AKI. The surgery in itself, especially emergency and major surgery in the critically ill, is associated with a high incidence of AKI...
December 2015: British Journal of Anaesthesia
Mohamad Ahmad, David Sommerfreund
No abstract text is available yet for this article.
March 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
M D Neuman
No abstract text is available yet for this article.
January 2016: British Journal of Anaesthesia
Peter Yi, Peter Pryzbylkowski
OBJECTIVE: To discuss the phenomenon of opioid induced hyperalgesia (OIH) and investigate the data and clinical recommendations available on this topic. DESIGN: A literature search on the topic of OIH was performed. Relevant studies pertaining to OIH were included in this review. RESULTS: Existing studies and reviews on the pathophysiology, diagnosis, and clinical management of OIH are discussed with updated data and literature references...
October 2015: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Dipak Kotecha, Jonathan P Piccini
Heart failure (HF) and atrial fibrillation (AF) are two conditions that are likely to dominate the next 50 years of cardiovascular (CV) care. Both are increasingly prevalent and associated with high morbidity, mortality, and healthcare cost. They are closely inter-related with similar risk factors and shared pathophysiology. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies...
December 7, 2015: European Heart Journal
Macaulay Amechi Chukwukadibia Onuigbo, Nneoma Agbasi
Acute kidney injury (AKI) is a relatively common complication of cardiothoracic surgery and has both short- and long-term survival implications, even when AKI does not progress to severe renal failure. Given that currently, there are no active effective treatments for AKI, other than renal replacement therapy when indicated, the focus of clinicians ought to be on prevention and risk factor management. In the AKI-surgery literature, there exists this general consensus that intraoperative hypotension (IH) following hypotensive anesthesia (HA) or controlled hypotension (CH) in the operating room has no significant short-term and long-term impacts on renal function...
2015: Journal of Renal Injury Prevention
Vanlapa Arnuntasupakul, Prangmalee Leurcharusmee, Daniel Chora De La Garza, Sonia Ah-Kye, Roderick J Finlayson, De Q H Tran
PURPOSE: This randomized trial aimed to validate a new method for brachial plexus blockade, i.e., targeted intracluster injection supraclavicular block (TII SCB), by comparing it with ultrasound-guided axillary block (AXB). We hypothesized that TII SCB would result in a shorter total anesthesia-related time. METHODS: Forty patients undergoing upper limb surgery were randomized to ultrasound-guided TII SCB (n = 20) or AXB (n = 20). In the TII SCB group, we deposited 16 mL of lidocaine 1...
December 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Malcolm G Munro, Lee A Christianson
Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon...
December 2015: Clinical Obstetrics and Gynecology
Shona Kalkman, Lotty Hooft, Johanne M Meijerman, Johannes T A Knape, Johannes J M van Delden
Automatic suspension of do-not-resuscitate (DNR) orders during general anesthesia does not sufficiently address a patient's right to self-determination and is a practice still observed among anesthesiologists today. To provide an evidence base for ethical management of DNR orders during anesthesia and surgery, the authors performed a systematic review of the literature to quantify the survival after perioperative cardiopulmonary resuscitation (CPR). Results show that the probability of surviving perioperative CPR ranged from 32...
March 2016: Anesthesiology
E Ashikhmina, M K Farber, K A Mizuguchi
BACKGROUND: Advances in understanding the pathogenesis, diagnosis and management of hypertrophic cardiomyopathy have resulted in increased longevity and a better quality of life of affected patients considering pregnancy. Several case series which focused predominantly on obstetric details have reported generally good outcomes. However, there remains a paucity of data on the specifics of obstetric anesthesia in women with hypertrophic cardiomyopathy. METHODS: After Institutional Review Board approval, we reviewed antepartum transthoracic echocardiograms, cardiology, obstetric, anesthetic, and nursing labor records with a focus on anesthesia for labor and delivery and early postpartum complications in patients with hypertrophic cardiomyopathy who delivered between January 1993 and December 2013...
November 2015: International Journal of Obstetric Anesthesia
2015-09-12 14:15:20
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