Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2009
Comparative StudyThe impact of an electronic reminder on the use of alarms after separation from cardiopulmonary bypass.
During cardiopulmonary bypass (CPB) monitor alarms are routinely disabled. Failure to reactivate these alarms after CPB may jeopardize patient safety. We have produced an electronic reminder that automatically alerts clinicians to reactivate alarms after CPB and have evaluated the alarm reactivation rate after its implementation. ⋯ Introducing an automatic electronic reminder significantly increased the rate of alarm reactivation after separation from CPB. Real-time computerized decision-support tools can be developed within anesthesia information management system and may be useful for improving safety during anesthesia.
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Anesthesia and analgesia · Apr 2009
The effects of spinal anesthesia on cerebral blood flow in the very elderly.
Aging and disease may make elderly patients particularly susceptible to hypotension during spinal anesthesia. However, the impact of small-dose bupivacaine on cerebral hemodynamics is not known. In this study, we assessed the effects of spinal anesthesia on cerebral blood flow (CBF) in very elderly patients. ⋯ In summary, spinal anesthesia results in a very small but statistically significant reduction of CBF velocity in very elderly patients.
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Anesthesia and analgesia · Apr 2009
In vivo detection of myocardial ischemia in pigs using visible light spectroscopy.
Monitoring tissue oxygenation (StO(2)) by visible light spectroscopy (VLS) can identify tissue ischemia, but its feasibility for detecting myocardial ischemia is not known. We hypothesized that VLS can reliably detect changes in myocardial StO(2) in pigs subjected to acute regional or global myocardial ischemia. ⋯ VLS is a reliable method of detecting alterations in myocardial StO(2) and can be a useful monitor for rapid identification of myocardial ischemia.
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Anesthesia and analgesia · Apr 2009
Cerebral oxygen saturation-time threshold for hypoxic-ischemic injury in piglets.
Detection of cerebral hypoxia-ischemia (H-I) and prevention of brain injury remains problematic in critically ill neonates. Near-infrared spectroscopy (NIRS), a noninvasive bedside technology could fill this role, although NIRS cerebral O(2) saturation (Sc(O2)) viability-time thresholds for brain injury have not been determined. We investigated the relationship between H-I duration at Sc(O2) 35%, a viability threshold which causes neurophysiological impairment, to neurological outcome. ⋯ A viability-time threshold for H-I injury is Sc(O2) of 35% for 2-3 h, heralded by abnormalities in NIRS and CFM during reperfusion. These findings suggest that NIRS and CFM might be used together to predict neurological outcome, and illustrate that there is a several hour window of opportunity during H-I to prevent neurological injury.
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Anesthesia and analgesia · Apr 2009
Transient metabolic alkalosis during early reperfusion abolishes helium preconditioning against myocardial infarction: restoration of cardioprotection by cyclosporin A in rabbits.
Intracellular acidosis during early reperfusion after coronary artery occlusion was recently linked to cardioprotection resulting from myocardial ischemic postconditioning. We tested the hypotheses that transient alkalosis during early reperfusion abolishes helium preconditioning and that the mitochondrial permeability transition pore inhibitor cyclosporin A (CsA) restores the cardioprotective effects of helium during alkalosis in vivo. ⋯ The results demonstrate that transient alkalosis during early reperfusion abolishes helium preconditioning in rabbits. CsA restored helium-induced cardioprotection during alkalosis, suggesting that helium preconditioning inhibits mitochondrial permeability transition pore formation by maintaining intracellular acidosis during early reperfusion.