Anesthesiology
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Editorial Comment
Estimated glomerular filtration rate: more bang for the buck.
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Review Meta Analysis
Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis.
Renal impairment as indicated by low eGFR is associated with early post-operative mortality, particularly following cardiac or vascular surgery.
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Randomized Controlled Trial
Impact of entropy monitoring on volatile anesthetic uptake.
Electroencephalogram-derived monitoring to assess anesthetic depth may allow more accurate hypnotic drug administration, resulting in decreased anesthetic drug consumption. The authors hypothesized that the use of M-Entropy monitoring (Datex-Ohmeda, Helsinki, Finland) is associated with reduced sevoflurane uptake (primary outcome) in patients undergoing major abdominal surgery. ⋯ Monitoring the depth of anesthesia using M-Entropy was associated with a significant reduction in sevoflurane uptake.
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Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. ⋯ Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.