Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2017
Noninfectious Fever in the Near-Term Pregnant Rat Induces Fetal Brain Inflammation: A Model for the Consequences of Epidural-Associated Maternal Fever.
Women laboring with epidural analgesia experience fever much more frequently than do women who chose other forms of analgesia, and maternal intrapartum fever is associated with numerous adverse consequences, including brain injury in the fetus. We developed a model of noninfectious inflammatory fever in the near-term pregnant rat to simulate the pathophysiology of epidural-associated fever and hypothesized that it would produce fetal brain inflammation. ⋯ Noninfectious inflammatory fever is inducible in the near-term pregnant rat by injection of IL-6 at levels comparable to those observed during human epidural labor analgesia. Maternal IL-6 injection causes neuroinflammation in the fetus.
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Anesthesia and analgesia · Dec 2017
ReviewRefractory Intracranial Hypertension: The Role of Decompressive Craniectomy.
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure. ⋯ Surgery also reduces mortality in those >60 years, but results in a higher proportion of severely disabled survivors compared to medical therapy in this age group. Decisions to recommend decompressive craniectomy must always be made not only in the context of its clinical indications but also after consideration of an individual patient's preferences and quality of life expectations. This narrative review discusses the management of intractable intracranial hypertension in adults, focusing on the role of decompressive craniectomy in patients with traumatic brain injury and acute ischemic stroke.
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Anesthesia and analgesia · Dec 2017
Observational StudyReliability of Point-of-Care Hematocrit Measurement During Liver Transplantation.
Although point-of-care (POC) analyzers are commonly used during liver transplantation (LT), the accuracy of hematocrit measurement using a POC analyzer has not been evaluated. In this retrospective observational study, we aimed to evaluate the accuracy of hematocrit measurement using a POC analyzer and identify potential contributors to the measurement error and their influence on mistransfusion during LT. ⋯ Hematocrit measured using the POC device tends to be lower than the laboratory hematocrit measured during LT. Commonly encountered laboratory abnormalities during LT include hypoalbuminemia, hypoproteinemia, and hyperglycemia, which may contribute to falsely low-measured POC hematocrit. Careful consideration of these confounders may help reduce overtransfusion that occurs due to falsely low-measured POC hematocrit.
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Anesthesia and analgesia · Dec 2017
End-Expiratory Occlusion Test Predicts Fluid Responsiveness in Patients With Protective Ventilation in the Operating Room.
End-expiratory occlusion test (EEOT) has been proposed to predict fluid responsiveness in mechanically ventilated intensive care unit patients. The utility of this test during low-tidal-volume ventilation remains uncertain. This study aimed to determine whether hemodynamic variations induced by EEOT could predict the effect of volume expansion in patients with protective ventilation in the operating room. ⋯ Changes in stroke volume index induced by EEOT can predict fluid responsiveness in patients with protective ventilation in the operating room. This test may have potential applications.
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Anesthesia and analgesia · Dec 2017
ReviewAortocaval Compression Syndrome: Time to Revisit Certain Dogmas.
More than 70 years ago, the phenomenon of "postural shock" in the supine position was described in healthy women in late pregnancy. Since then, avoidance of the supine position has become a key component of clinical practice. Indeed, performing pelvic tilt in mothers at term to avoid aortocaval compression is a universally adopted measure, particularly during cesarean delivery. ⋯ For example, magnetic resonance imaging of women at term in the supine and tilted positions has challenged the dogma that 15° of left tilt is sufficient to relieve inferior vena cava compression. A clinical investigation of healthy term women undergoing elective cesarean delivery with spinal anesthesia found no difference in neonatal acid-base status between women randomized to be either tilted to the left by 15° or to be in the supine position, if maternal systolic blood pressure is maintained at baseline with a crystalloid coload and prophylactic phenylephrine infusion. This review presents a fresh look at the decades of evidence surrounding this topic and proposes a reevaluation and appraisal of current guidelines regarding entrenched practices.