Anesthesia and analgesia
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Diagnosis of sepsis in the postoperative period is a challenge. Measurements of inflammatory markers, such as C-reactive protein (CRP), have been proposed in medical patients, but the interpretation of these values in surgical patients is more difficult. We evaluated the changes in blood CRP levels and white blood cell count in postoperative patients with and without infection. ⋯ CRP levels increase in the first week after major surgery but to a much larger extent in infected than in noninfected patients. Persistently high CRP levels after POD 4, especially when >100 mg/L, suggest the presence of a postoperative infection.
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Anesthesia and analgesia · Sep 2014
Randomized Controlled Trial Multicenter StudyPerioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic Trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery).
Goal directed fluid and vasoactive therapy using a non-invasive cardiac output monitor does not reduce complications after major abdominal surgery.
pearl -
Anesthesia and analgesia · Sep 2014
Review Meta Analysis Comparative StudyNeuraxial Anesthesia for the Prevention of Postoperative Mortality and Major Morbidity: An Overview of Cochrane Systematic Reviews.
Neuraxial anaesthesia when compared with general anaesthesia may reduce 30 day mortality in patients with intermediate-to-high cardiac risk.
pearl -
Anesthesia and analgesia · Sep 2014
Randomized Controlled TrialUltrasound-Guided Pulsed Radiofrequency Stimulation of the Suprascapular Nerve for Adhesive Capsulitis: A Prospective, Randomized, Controlled Trial.
Pulsed radiofrequency stimulation of the suprascapular nerve improves pain and range of motion in those with adhesive capsulitis.
pearl -
Anesthesia and analgesia · Sep 2014
Molecular Size and Origin Do Not Influence the Harmful Side Effects of Hydroxyethylstarch on Human Proximal Tubule Cells (HK-2) In Vitro.
Recently, clinical trials revealed renal impairment induced by hydroxyethyl starch (HES) in septic patients. In prior studies, we managed to demonstrate that HES accumulated in renal proximal tubule cells (PTCs). The related pathomechanism has not yet been discovered. To validate our hypothesis that the HES molecule itself is harmful, regardless of its molecule size or origin, we conducted a comprehensive study to elucidate the influences of different HES preparations on PTC viability in vitro. ⋯ For the first time, we were able to show that only the total mass of HES molecules applied is responsible for the harmful impact on renal PTC in vitro. Neither molecular size nor their origin showed any relevance.