Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2012
Review Case ReportsEchocardiographic assessment of atrial septal defects.
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Anesthesia and analgesia · Oct 2012
Minute-to-minute urine flow rate variability: a new renal physiology variable.
Urine output is a surrogate for tissue perfusion and is typically measured at 1-hour intervals. Because small urine volumes are difficult to measure in urine collection bags, considerable over- or underestimation is common. To overcome these shortcomings, digital urine meters were developed. Because these monitors measure urine volume in 1-minute intervals, they provide minute-to-minute measurements of the urine flow rate (UFR). In a previous study, we observed that the minute-to-minute variability in the UFR disappeared during hypovolemia. The aim of this study was to describe the minute-to-minute variability in the UFR as a new physiological variable and to show its relationship to blood volume depletion. ⋯ The UFR and its minute-to-minute variability decrease during hemorrhaging. The variability in the UFR may be useful as an aid for the diagnosis of hypovolemia.
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Anesthesia and analgesia · Oct 2012
Bedside assessment of total systemic vascular compliance, stressed volume, and cardiac function curves in intensive care unit patients.
Mean systemic filling pressure (Pmsf) can be measured at the bedside with minimally invasive monitoring in ventilator-dependent patients using inspiratory hold maneuvers (Pmsf(hold)) as the zero flow intercept of cardiac output (CO) to central venous pressure (CVP) relation. We compared Pmsf(hold) with arm vascular equilibrium pressure during vascular occlusion (Pmsf(arm)) and their ability to assess systemic vascular compliance (Csys) and stressed volume by intravascular fluid administration. ⋯ Csys, stressed volume, and cardiac function curves can be determined at the bedside and can be used to characterize patients' hemodynamic status.
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Anesthesia and analgesia · Oct 2012
Review Meta AnalysisDoes intraoperative ketamine attenuate inflammatory reactivity following surgery? A systematic review and meta-analysis.
Reports regarding the ability of the anesthetic drug ketamine to attenuate the inflammatory response to surgery are conflicting. In this systematic review we examined the effect of perioperative ketamine administration on postoperative inflammation as assessed by concentrations of the biomarker interleukin-6 (IL-6). ⋯ It can be concluded that intraoperative administration of ketamine significantly inhibits the early postoperative IL-6 inflammatory response. Future studies should further examine the anti-inflammatory effect of ketamine during major surgery, determine whether ketamine treatment alters functional outcomes, elucidate the mechanisms of its anti-inflammatory effect, and suggest an appropriate dosing regimen.
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Anesthesia and analgesia · Oct 2012
Randomized Controlled TrialPosterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine.
Dexmedetomidine, an α(2)-receptor agonist, prolongs analgesia when used in neuraxial and IV blocks. We evaluated the effect of dexmedetomidine added to ropivacaine for tibial nerve block on the duration of the sensory blockade. ⋯ Dexmedetomidine added to ropivacaine for tibial nerve block prolongs the duration of sensory blockade with similar onset time. However, patients should be monitored for potential adverse effects such as hypotension, bradycardia, and sedation.