Anesthesiology
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Case Reports
Case Scenario: Perioperative Management of a Young Woman with Fontan Repair for Major Gynecologic Surgery.
Effective treatment for many congenital heart diseases diagnosed before birth has become available since the last three decades. Continuous improvements in surgical knowledge and techniques have allowed patients born with severe heart defects to survive through adulthood. However, palliative surgery often implies profound modifications of classical circulatory physiology, which must be taken into account particularly when general anesthesia is needed for major noncardiac surgery. ⋯ In this case scenario, the authors report the perioperative management of a young woman who underwent major gynecologic surgery, who was managed using a transpulmonary thermodilution technique that was deemed more accurate than noncalibrated pulse-contour method and also able to provide more information regarding preload status. The authors adopted an integrated approach merging together hemodynamic and functional data (ScvO2 and venoarterial CO2 difference) to assess the appropriateness of hemodynamic management. The authors describe also pathophysiologic changes during such condition and also potential drawbacks of chosen technique.
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Postoperative cognitive dysfunction (POCD) affects 16 to 21% of the elderly 3 months after anesthesia and surgery and is associated with adverse outcomes. The exact cause of POCD remains unknown. The authors hypothesized that elderly individuals with Alzheimer disease (AD) neuropathology, identified by cerebrospinal fluid (CSF) analysis, would have increased the risk for POCD. ⋯ Low CSF Aβ1-42 may be a significant predictor of POCD at 3 months. This indicates that patients with AD neuropathology even in the absence of clinically detectable AD symptoms may be susceptible to POCD.
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Train-of-four ratio (TOFR) is often used to evaluate muscle relaxation caused by neuromuscular-blocking agents (NMBAs). However, it is unknown whether TOFR reliably correlates with the first twitch tension (T1) in patients with myasthenia gravis (MG). By using rat models of experimental autoimmune MG (EAMG), the authors verified the hypothesis that the severity of MG influences the relationship between TOFR and T1. ⋯ Severity of MG influences the relationship between TOFR and T1, together with changes in run-down of endplate potentials and those around the neuromuscular junction in rats. TOFR may, therefore, not be an accurate indicator of recovery from NMBAs in MG patients.