Anesthesiology
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Randomized Controlled Trial Comparative Study
Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial.
: Acute kidney injury (AKI) is a serious complication of cardiac surgery, and preoperative anemia and perioperative erythrocyte transfusion are important risk factors. Prophylactic erythrocyte transfusion in anemic patients may, therefore, protect against AKI. ⋯ : In anemic patients, prophylactic erythrocyte transfusion reduces perioperative anemia and erythrocyte transfusions, and may reduce plasma iron levels. Adequately powered studies assessing the effect of this intervention on AKI are warranted.
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Comparative Study
Surgery and brain atrophy in cognitively normal elderly subjects and subjects diagnosed with mild cognitive impairment.
Structural magnetic resonance imaging is used to longitudinally monitor the progression of Alzheimer disease from its presymptomatic to symptomatic phases. Using magnetic resonance imaging data from the Alzheimer's Disease Neuroimaging Initiative, we tested the hypothesis that surgery would impact brain parameters associated with progression of dementia. ⋯ Elderly subjects after surgery experienced an increased rate of brain atrophy during the initial evaluation interval, a time associated with enhanced risk for postoperative cognitive dysfunction. Although there was no difference in atrophy rate by diagnosis, subjects with mild cognitive impairment suffered greater subsequent cognitive effects.
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Comparative Study
Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study.
Postoperative stroke is a rare but major complication after surgery. The most often proposed mechanism is an embolus originating from the heart or great vessels. The role of intraoperative hypotension in the occurrence and evolution of postoperative stroke is largely unknown. ⋯ Intraoperative hypotension might play a role in the development of postoperative ischemic stroke. Especially for mean blood pressure values decreasing more than 30% from baseline blood pressure, an association with postoperative ischemic stroke risks was observed.
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Comparative Study
Choice of anesthetic combination determines Ca2+ leak after ischemia-reperfusion injury in the working rat heart: favorable versus adverse combinations.
There is a lack of studies investigating cardioprotection by common combinations of anesthetics. However, because a general anesthetic consists of a mixture of drugs with potentially interfering effects on signaling and cytoprotection, the most favorable combination should be used. ⋯ The choice of anesthetic combination determines the postischemic Ca leak and intracellular overload. The results from these experiments will help to design studies for optimizing perioperative cardioprotection in high-risk surgical patients.