Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2010
Perioperative mortality in patients with pulmonary hypertension undergoing major joint replacement.
There is a paucity of perioperative outcomes data for patients with chronic pulmonary hypertension (PHTN) undergoing noncardiac surgery. Clinicians, therefore, have little information on which to evaluate the risk for morbidity and mortality in this patient population. In this study, we evaluated the incidence and risks of perioperative morbidity and mortality in patients with PHTN undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). ⋯ This analysis demonstrates that patients with PHTN are at increased risk for perioperative mortality after THA and TKA.
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Anesthesia and analgesia · Nov 2010
The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) induces a systemic inflammatory response. The magnitude and consequences in infants remain unclear. We assessed the relationship between inflammatory state and clinical outcomes in infants undergoing CPB. ⋯ Greater preoperative cytokine and CRP production in younger infants did not correlate with postoperative outcomes; correlation between postoperative inflammatory mediator production and clinical course was statistically significant but clinically modest. We conclude that in infants undergoing low-to-moderate-complexity cardiac surgery in a single high-volume center, the contribution of inflammatory mediator production to postoperative morbidity is relatively limited.
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Anesthesia and analgesia · Nov 2010
Comparative StudyOral contrast for abdominal computed tomography in children: the effects on gastric fluid volume.
Oral enteric contrast medium (ECM) is frequently administered to achieve visualization of the gastrointestinal tract during abdominal evaluation with computed tomography (CT). Administering oral ECM less than 2 hours before sedation/anesthesia violates the nothing-by-mouth guidelines and in theory may increase the risk of aspiration pneumonia. In this study we measured the residual gastric fluid when using a protocol in which ECM is administered up to 1 hour before anesthesia/sedation. We hypothesized that patients receiving ECM 1 hour before anesthesia/sedation would have residual gastric fluid volume (GFV) >0.4 mL/kg. ⋯ For children receiving an abdominal CT, the residual GFV exceeded 0.4 mL/kg in 49% (178/365) of those who received oral ECM up to 1 hour before anesthesia/sedation in comparison with 23% (11/47) of those who received IV-only contrast.
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Anesthesia and analgesia · Nov 2010
Comparative StudyPropofol decreases neuronal population spiking activity in the subthalamic nucleus of Parkinsonian patients.
Implantation of deep brain stimulation (DBS) electrodes in the subthalamic nucleus (STN) for the treatment of Parkinson disease is often performed using microelectrode recording (MER) of STN population spike activity. The extent to which sedative drugs interfere with MER is unknown. We recorded the population activity of STN neurons during propofol sedation and examined its effect on neuronal activity. ⋯ Propofol administration leads to a significant decrease of STN neuronal activity. Thus, it may interfere with MER identification of the STN borders. However, activity returns to baseline shortly after administration stops. Therefore, propofol can be safely used until shortly before MER for DBS.
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Anesthesia and analgesia · Nov 2010
A decision-tree model for predicting extubation outcome in elderly patients after a successful spontaneous breathing trial.
The commonly used single tests, based on a 1-time measurement of a physiologic variable, are often poorly predictive of tracheal extubation outcome because they examine only a single aspect of physiological function that affects the extubation outcome. We hypothesized that the construction of a decision-tree model, which includes multiple variables and considers the changes of these variables, may more accurately predict successful extubation. ⋯ If the current tree model is confirmed by a prospective study with a larger sample size, it would be useful in guiding physicians making extubation decisions in elderly medical intensive care unit patients.