Anesthesia and analgesia
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Chronological age is a well-established risk factor for the development of cardiovascular diseases. The changes that accumulate in the vasculature with age, however, are highly variable. ⋯ In this review, we highlight some of the pathophysiological mechanisms that characterize the vascular aging phenotype. Furthermore, we provide an overview of the key outcome studies that address the value of these vascular health indices in general and discuss potential effects on perioperative cardiovascular outcomes.
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Anesthesia and analgesia · May 2011
Randomized Controlled TrialHigh-dose remifentanil suppresses sinoatrial conduction and sinus node automaticity in pediatric patients under propofol-based anesthesia.
We sought to determine the effect of remifentanil on sinus node function and the atrial-His (AH) interval in pediatric patients undergoing radiofrequency catheter ablation. ⋯ Remifentanil may inhibit both intraatrial conduction and sinus node automaticity, but it has no effect on conduction through the atrioventricular node. Dose dependency was not observed within the range of 0.2 to 0.4 μg · kg(-1) · min(-1) of remifentanil.
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Anesthesia and analgesia · May 2011
ReviewReview article: improving outcome after major surgery: pathophysiological considerations.
Surgical and anesthesia-related techniques may reduce physical stress for patients undergoing high-risk surgery, but major surgery is increasingly performed in patients with substantial comorbidities. Strategies for improving the outcome for such patients include approaches that both increase tissue oxygen delivery and reduce metabolic demand. However, these strategies have produced conflicting results. ⋯ Our aim in this review is to provide a survey of fields of opportunities for improving outcome after major surgery. The issues are approached from 3 different angles: the view of the patient, the view of the surgical intervention, and the view of the anesthesia. Special attention is also given to what could be considered the result of the interaction among the 3: perioperative inflammation and immune response.
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Anesthesia and analgesia · May 2011
Randomized Controlled TrialBrief report: the effect of suggestion on unpleasant dreams induced by ketamine administration.
The use of ketamine may be associated with the recall of unpleasant dreams after sedation. We hypothesized that a positive suggestion before sedation could reduce the incidence of ketamine-induced unpleasant dreams. To test this hypothesis, we randomized 100 patients receiving sedation with ketamine for their procedure into 2 groups with 1 group having an anesthesiologist provide a mood-elevating suggestion to the patient before ketamine administration (suggestion group), whereas in the control group no suggestion was provided. ⋯ In those patients who lost consciousness, the frequencies of grades 1, 2, 3, 4, and 5 were 0%, 0%, 46%, 24%, and 30% in the suggestion group and were 6%, 2%, 70%, 12%, and 10%, respectively, in the control group (P=0.01). In the intent-to-treat population the overall frequency between groups was very similar. This study implies that when administering ketamine as part of a sedation regimen, positive suggestion may help reduce the recall of unpleasant dreaming.
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Anesthesia and analgesia · May 2011
Cognitive and functional predictors and sequelae of postoperative delirium in elderly patients undergoing elective joint arthroplasty.
Postoperative delirium (POD) is common in the elderly and associated with adverse outcomes. The cognitive and functional sequelae of POD in elective surgical patients are not known. We sought to determine whether (1) lower scores on sensitive neurocognitive tests are an independent risk factor for POD in elderly surgical patients, and (2) POD predicts cognitive and functional decline 3 months postoperatively. ⋯ Subtly reduced preoperative neurocognitive and functional status predict POD. However, in the small group that developed POD, there was no evidence of cognitive and functional decline 3 months after surgery. POD is associated with decreased preoperative cognitive reserve but, in elderly elective surgical patients, may be without adverse cognitive or functional sequelae 3 months postoperatively.