Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2011
Comparative StudyContinuous noninvasive hemoglobin monitoring during complex spine surgery.
Monitoring hemoglobin levels in the operating room currently requires repeated blood draws, several steps, and a variable time delay to receive results. Consequently, blood transfusion management decisions may be delayed or made before hemoglobin results become available. The ability to measure hemoglobin continuously and noninvasively may enable a more rapid assessment of a patient's condition and more appropriate blood management. A new technology, Pulse CO-Oximetry, provides a continuous, noninvasive estimate of hemoglobin concentration (SpHb) from a sensor placed on the finger. We evaluated the accuracy of SpHb compared with laboratory CO-Oximetry measurements of total hemoglobin (tHb) during complex spine procedures in patients at high risk for blood loss. ⋯ Continuous, noninvasive hemoglobin measurement via Pulse CO-Oximetry demonstrated clinically acceptable accuracy of hemoglobin measurement within 1.5 g/dL compared with a standard laboratory reference device when used during complex spine surgery. This technology may provide more timely information on hemoglobin status than intermittent blood sample analysis and thus has the potential to improve blood management during surgery.
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Anesthesia and analgesia · Dec 2011
ReviewBrief preoperative smoking abstinence: is there a dilemma?
The concern that stopping smoking shortly (<8 weeks) before surgery increases postoperative pulmonary complications poses a barrier to tobacco use interventions in surgical patients. We show how this concern arose from a misinterpretation of initial studies and has remained in the medical literature despite the accumulation of later evidence. The persistence of unsubstantiated concepts is not uncommon and can have a significant impact on medical practice. Although it may take several weeks to derive pulmonary benefit from quitting, fear of an increase in pulmonary complications should not be a barrier for clinicians to help their patients quit smoking at any time before surgery.
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Anesthesia and analgesia · Dec 2011
Comparative StudyMorphine-induced epidermal growth factor pathway activation in non-small cell lung cancer.
Epidermal growth factor receptor (EGFR) is coactivated by the μ-opioid receptor (MOR), expressed on non-small cell lung cancer (NSCLC) cells and human lung cancer. We hypothesized that clinically used opioid analgesics that are MOR agonists coactivate EGFR, resulting in growth- and survival-promoting signaling. ⋯ Morphine-induced phosphorylation of EGFR occurs via ORs, leading to downstream MAPK/ERK, Akt phosphorylation, cell proliferation, and increased invasion. Notably, ORs are also associated with EGF-induced phosphorylation of EGFR. Increased coexpression of MOR and EGFR in human lung cancer suggests that morphine may have a growth-promoting effect in lung cancer.
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Anesthesia and analgesia · Dec 2011
ReviewActivation of the hemostatic system during cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) is a unique clinical scenario that results in widespread activation of the hemostatic system. However, surgery also results in normal increases in coagulation activation, platelet activation, and fibrinolysis that are associated with normal wound hemostasis. Conventional CPB interferes with normal hemostasis by diluting hemostatic cells and proteins, through reinfusion of shed blood, and through activation on the bypass circuit surface of multiple systems including platelets, the kallikrein-kinin system, and fibrinolysis. ⋯ Additionally, strategies used to reduce this activation are discussed, including limiting cardiotomy suction, increasing circuit biocompatibility, antithrombin supplementation, and antifibrinolytic use. Determining which patients will most benefit from specific therapies will ultimately require investigation into genetic phenotypes of coagulation protein expression. Until that time, however, a combination of approaches to reduce the hemostatic activation from CPB seems warranted.