Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this article is to review the effective options for the reversal of vitamin K antagonists (warfarin and it coumarin analogues) and to help identify the option best suited for the patient requiring urgent surgery. ⋯ In order to limit the blood loss associated with surgery and the management of uncontrolled bleeding, PCC is an important addition to our therapeutic armamentarium in the reversal of vitamin K antagonists.
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Poor outcome in patients with cerebral vasospasm following subarachnoid hemorrhage remains a serious clinical problem. The current management with focus on the cerebrovascular constriction accounts for the use of "triple-H" therapy (hypertension, hypervolemia, and hemodilution) to enhance cerebral blood flow through constricted vessels. Recent work suggests that spreading depression (a stereotypical response of cerebral cortical tissue to noxious stimuli with subsequent oligemic blood flow) occurs in patients with cerebral vasospasm. A narrative review was conducted to examine the relationship between spreading depression and subarachnoid hemorrhage and to identify the anesthetic effects on the propagation of spreading depression. ⋯ The implication for clinical management is discussed supposing glial cell dysfunction is an underlying mechanism responsible for the vascular spasm.
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Meta Analysis
Anesthetic dose neuraxial blockade increases the success rate of external fetal version: a meta-analysis.
This study is a meta-analysis evaluating the efficacy of central neuraxial blockade (CNB) (epidural or spinal) to facilitate fetal version. ⋯ Anesthetic dose neuraxial blockade increases the success rate of external fetal version.
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Obesity, epidural analgesia, and subcostal incision are risk factors for postoperative desaturation.
This study was designed to determine the incidence of oxygen desaturation after upper abdominal surgery during the first 48 hr on general surgical wards and also to identify risk factors for oxygen desaturation. ⋯ Oxygen desaturation is common after upper abdominal surgery, and the risk factors are obesity, a subcostal incision, and neuraxial opioid administration.