Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2020
ReviewPerioperative Management of Children on Ketogenic Dietary Therapies.
Ketogenic diet therapy (KDT) is an effective treatment modality for children with drug-resistant epilepsy and certain other metabolic and neurologic disorders. With a resurgence of interest in KDT, pediatric anesthesiologists are increasingly encountering children on KDT for a variety of surgical and medical procedures. ⋯ Recommendations for the perioperative anesthetic management of children on KDT are summarized. A comprehensive table listing the carbohydrate content of common anesthetic drugs is also included.
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Anesthesia and analgesia · Dec 2020
Multicenter StudyAn Implementation-Effectiveness Study of a Perioperative Delirium Prevention Initiative for Older Adults.
Postoperative delirium is a common and serious problem for older adults. To better align local practices with delirium prevention consensus guidelines, we implemented a 5-component intervention followed by a quality improvement (QI) project at our institution. ⋯ A perioperative delirium prevention intervention was associated with reduced administration of Beers PIMs to older adults.
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Anesthesia and analgesia · Dec 2020
ReviewSystemic Inflammatory Response Syndrome After Surgery: Mechanisms and Protection.
The immune system is an evolutionary hallmark of higher organisms that defends the host against invading pathogens and exogenous infections. This defense includes the recruitment of immune cells to the site of infection and the initiation of an inflammatory response to contain and eliminate pathogens. However, an inflammatory response may also be triggered by noninfectious stimuli such as major surgery, and, in case of an overshooting, still not comprehensively understood reaction, lead to tissue destruction and organ dysfunction. ⋯ These options depend on uncovering the underlying mechanisms and could include pharmacologic agents, remote ischemic preconditioning protocols, cytokine blockade or clearance, and optimization of surgical procedures, anesthetic regimens, and perioperative inflammatory diagnostic assessment. Currently, a large gap between basic science and clinically confirmed data exists due to a limited evidence base of translational studies. We thus summarize important steps toward the understanding of the precise time- and space-regulated processes in systemic perioperative inflammation.
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Anesthesia and analgesia · Dec 2020
Meta AnalysisPerioperative Lung Protection: General Mechanisms and Protective Approaches.
Postoperative pulmonary complications (PPCs) are one of the most important cause of perioperative morbidity and mortality in patients undergoing noncardiothoracic surgery, leading to increased hospital length of stay and mortality rate. The principal purpose of this review is to provide an overview of the perioperative lung protection strategies in patients undergoing elective noncardiothoracic surgery, informing clinicians on evidence-based perioperative care pathways. We also conducted a systematic review and meta-analysis of randomized controlled trials in noncardiothoracic surgery focusing on the following aspects: preoperative physiotherapy, intraoperative protective mechanical ventilation, postoperative prophylactic continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC), and postoperative physiotherapy. ⋯ Lung-protective strategies should be considered throughout the entire perioperative period. The prophylactic use of strategies initiated in the postoperative period only, such as physiotherapy, CPAP, or HFNC, offers limited benefits. Physiotherapy and patient training should be started early in the preoperative phase, and intraoperative protective mechanical ventilation should be titrated on an individual basis taking into account all the available evidence.