Anesthesiology
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Multicenter Study
An Assessment of Penetrance and Clinical Expression of Malignant Hyperthermia in Individuals Carrying Diagnostic Ryanodine Receptor 1 Gene Mutations.
Malignant hyperthermia (MH) is a potentially lethal disorder triggered by certain anesthetics. Mutations in the ryanodine receptor 1 (RYR1) gene account for about half of MH cases. Discordance between the low incidence of MH and a high prevalence of mutations has been attributed to incomplete penetrance, which has not been quantified yet. The authors aimed to examine penetrance of MH-diagnostic RYR1 mutations and the likelihood of mutation carriers to develop MH, and to identify factors affecting severity of MH clinical expression. ⋯ Nine MH-diagnostic RYR1 mutations have sex-dependent incomplete penetrance, whereas MH clinical expression is influenced by patient's age and the type of anesthetic. Our quantitative evaluation of MH penetrance reinforces the notion that a previous uneventful anesthetic does not preclude the possibility of developing MH.
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Randomized Controlled Trial Multicenter Study
Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium: Results of the REDUCE Study.
Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life. ⋯ Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.
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During anesthesia oxygenation is impaired, especially in the elderly or obese, but the mechanisms are uncertain. ⋯ PaO2/FIO2 ratio was impaired during anesthesia, and the impairment increased with age and body mass index. Shunt was related to atelectasis and was a more important cause of oxygenation impairment in middle-aged patients, whereas low(Equation is included in full-text article.), likely caused by airway closure, was more important in elderly patients. Shunt but not low(Equation is included in full-text article.)increased with increasing body mass index. Thus, increasing age and body mass index impaired gas exchange by different mechanisms during anesthesia.
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Anesthetic-induced loss of consciousness is accompanied by changes in functional connectivity within and between brain networks. ⋯ Anesthesia-induced alterations of functional connectivity are dynamic despite the stable and prolonged administration of isoflurane, in the absence of any noxious stimuli. Changes in connectivity over time will likely yield more information as a marker or mechanism of surgical anesthesia than any single pattern.
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Randomized Controlled Trial Multicenter Study
Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.
Why is this interesting?
Lidocaine/lignocaine has been increasingly used intra- and perioperatively as an analgesic adjunct, with further research suggesting a potential neuroprotective effect. Cognitive decline is a common problem following cardiac surgery (40-50%), with lidocaine potentially offering a simple and safe intervention to reduce this complication. Past studies have showed conflicting results.
What did they do?
This Duke University team randomized 478 cardiac surgery patients across multiple centres to lidocaine intraoperatively (1 mg/kg bolus then decreasing infusions across 2.9 / 1.5 / 0.6 mg/kg/h over 48 hours) or blinded control. Cognitive function was assessed at 6 weeks and 1 year.
They found...
No difference in cognitive deficit between lidocaine infusion and saline control at either 6 weeks or 1 year.
Be smart
Intravenous lidocaine infusion remains relatively safe, practical and is still likely a useful analgesic adjunct. Similar to magnesium, which has been shown to be neuroprotective in premature infants but not adult cardiac patients, the problem for lidocaine may well be context rather than physiological benefit itself.
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