Anesthesiology
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Comparative Study
Blood transfusion promotes cancer progression: a critical role for aged erythrocytes.
In cancer patients, allogeneic blood transfusion is associated with poorer prognosis, but the independent effect of the transfusion is controversial. Moreover, mediating mechanisms underlying the alleged cancer-promoting effects of blood transfusion are unknown, including the involvement of donors' leukocytes, erythrocytes, and soluble factors. ⋯ In rats, transfusion of fresh blood is less harmful than transfusion of stored blood in the context of progressing malignancies. Further studies should address mediating mechanisms through which erythrocytes' storage duration can impact the rate of complications while treating malignant diseases and potentially other pathologies.
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Randomized Controlled Trial Comparative Study
Thoracic epidural analgesia with low concentration of bupivacaine induces thoracic and lumbar sympathetic block: a randomized, double-blind clinical trial.
Clinical benefits of thoracic epidural anesthesia (TEA) are partly ascribed to thoracic sympathetic block. However, data regarding sympathetic activity during TEA are scarce and contradictory. This prospective, randomized, double-blind study evaluated the segmental propagation of sympathetic block after low-concentration, high-volume TEA using digital thermography. ⋯ TEA with 10 ml bupivacaine, 0.25%, induced thoracic and lumbar sympathetic block that precedes and exceeds sensory block. Caudal limit of sympathetic block could not be demonstrated in this study.
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Randomized Controlled Trial Comparative Study
Electroencephalographic order pattern analysis for the separation of consciousness and unconsciousness: an analysis of approximate entropy, permutation entropy, recurrence rate, and phase coupling of order recurrence plots.
Nonlinear electroencephalographic parameters, e.g., approximate entropy, have been suggested as measures of the hypnotic component of anesthesia. Compared with linear methods, they may detect additional information and quantify the irregularity of a dynamical system. High dimensionality of a signal and disturbances may affect these parameters and change their ability to distinguish consciousness from unconsciousness. Methods of order pattern analysis, in this investigation represented by permutation entropy, recurrence rate, and phase coupling of order recurrence plots, are suitable for any type of time series, whether deterministic or noisy. They may provide a better estimation of the hypnotic component of anesthesia than other nonlinear parameters. ⋯ Parameters of the nonlinear method order pattern analysis separate consciousness from unconsciousness and are grossly independent of high-frequency components of the electroencephalogram.
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Comparative Study
Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation.
Emergent intubation is associated with a high complication rate. These intubations are often performed by resident physicians in teaching hospitals. The authors evaluated whether supervision by an anesthesia-trained intensivist decreases complications of emergent intubations. ⋯ Supervision by an attending anesthesiologist was associated with a decreased incidence of complications during emergent intubations.