Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2008
Case ReportsCar accidents after ambulatory surgery in patients without an escort.
Occasionally, ambulatory surgical patients present without an escort for their procedure. This creates a dilemma for caregivers, and allowing patients to drive may have an impact on their safety. The Canadian Medical Protective Association is a mutual defense organization for 95% of Canadian physicians. ⋯ Both had a car accident and sustained serious injuries. Based on this we do not recommend discharge without an escort after general anesthesia, regional anesthesia, monitored anesthesia or sedation. Driving after ambulatory surgery cannot be considered safe and caregivers need to verify a safe ride home.
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Anesthesia and analgesia · Mar 2008
Comparative StudyMeasurement of blood flow index during antegrade selective cerebral perfusion with near-infrared spectroscopy in newborn piglets.
Neonates with complex congenital heart defects have traditionally undergone surgery during deep hypothermic cardiac arrest (HCA). Selective cerebral perfusion (SCP) is thought to minimize ischemic brain injury by providing adequate cerebral blood flow. We investigated SCP with different flow rates compared with HCA with respect to cerebral perfusion and tissue oxygenation as assessed by near-infrared spectroscopy. ⋯ Both BFI and FV(mean) suggested increased cerebral perfusion in the SCP 50 group compared with the HCA and SCP 25 groups. TOI was significantly higher in both the SCP 25 and SCP 50 groups compared with HCA. SCP at 25 mL x kg(-1) x min(-1) may be most appropriate for cerebral protection.
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Anesthesia and analgesia · Mar 2008
The effects of transient cerebral ischemia on vasopressin-induced vasoconstriction in rabbit cerebral vessels.
Vasopressin is a drug of choice for use during cardiopulmonary resuscitation because several experimental studies have shown that it is better than epinephrine at increasing systemic perfusion pressure and improving cerebral perfusion pressure without increasing myocardial oxygen consumption. We used a pial window preparation to determine the effects of vasopressin when applied topically to pial vessels and whether any effects were altered after cerebral ischemia in rabbits (n = 27). ⋯ Topical application of AVP (except at the lowest concentration used here) induced concentration-dependent vasoconstriction of pial arterioles in anesthetized rabbits. The vasoconstrictor effect of 10(-7) M AVP was reduced after transient (5-min) cerebral ischemia.
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Anesthesia and analgesia · Mar 2008
Practice GuidelineACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery).
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Anesthesia and analgesia · Mar 2008
The effect of limited rewarming and postoperative hypothermia on cognitive function in a rat cardiopulmonary bypass model.
Clinical studies have failed to demonstrate significant benefits of hypothermia for the prevention of postoperative cognitive dysfunction (POCD) after cardiopulmonary bypass (CPB). One explanation for this might be that potentially injurious cerebral hyperthermia occurs during rewarming at the end of CPB, off-setting the protective benefits of hypothermia. In this study, we investigated the relative influence of CPB temperature, rewarming strategies, and postoperative temperature in a rat CPB model. ⋯ The combination of hypothermic (32 degrees C) CPB coupled with limited rewarming and prolonged postoperative hypothermia (35 degrees C) decreased POCD after CPB in rats.