Anesthesia and analgesia
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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.
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Anesthesia and analgesia · Sep 2014
Comparative StudyAn Evaluation of a Zero-Heat-Flux Cutaneous Thermometer in Cardiac Surgical Patients.
Although core temperature can be measured invasively, there are currently no widely available, reliable, noninvasive thermometers for its measurement. We thus compared a prototype zero-heat-flux thermometer with simultaneous measurements from a pulmonary artery catheter. Specifically, we tested the hypothesis that zero-heat-flux temperatures are sufficiently accurate for routine clinical use. ⋯ Core temperature can be noninvasively measured using the zero-heat-flux method. Bias was small, but precision was slightly worse than our designated 0.5°C limits compared with measurements from a pulmonary artery catheter.
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Anesthesia and analgesia · Sep 2014
ReviewNeurodevelopmental assessment after anesthesia in childhood: review of the literature and recommendations.
Preclinical studies have established that anesthesia is toxic to the brain in neonatal animals, but scant research investigates the neurodevelopmental effects of exposure to anesthesia. In this article, we discuss the issue of outcome measurement of children after anesthesia administered between infancy and approximately 4 years of age. ⋯ The strengths and limitations of this literature is reviewed, followed by a discussion of how future trials investigating neurodevelopmental outcome after anesthesia might be improved by procedures designed specifically to assess the status of the central nervous system. Neuropsychological assessment is described and proposed as a way to increase the validity and sensitivity of forthcoming studies that intend to evaluate the short- and long-term effects of exposure to anesthesia during infancy and early childhood.
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Anesthesia and analgesia · Sep 2014
Editorial CommentThe growing burden of perioperative heart failure.
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Anesthesia and analgesia · Sep 2014
Assessment of Early Thromboelastometric Variables from Extrinsically Activated Assays With and Without Aprotinin for Rapid Detection of Fibrinolysis.
Although thromboelastometry (ROTEM®) and thrombelastography can be used for bedside diagnosis of fibrinolysis, the time needed for detection is often prolonged. Since untreated fibrinolysis can result in consumption of coagulation factors and bleeding, early diagnosis and decision making are desirable. Accordingly, we assessed ROTEM variables from extrinsically activated assays with (APTEM) and without (EXTEM) addition of aprotinin for their ability to rapidly identify fibrinolysis. Specifically, we tested the hypotheses that prolonged clotting time, clot formation time, low clot firmness (at 5, 10, 15, and 20 minutes, designated A5, A10, A15, and A20, respectively), low maximum clot firmness (MCF) in EXTEM assays, and differences in these variables from parallel APTEM and EXTEM assays (designated as Δvariables) predict fibrinolysis. ⋯ Low early values of clot firmness in extrinsically activated thromboelastometric assays are associated with fibrinolysis and improve its early detection. Additional assays with aprotinin fail to improve the early diagnosis of fibrinolysis compared with assays without aprotinin.