Journal of clinical anesthesia
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Observational Study
Cerebral oximetry index indicates delirium or stroke after carotid endarterectomy: An observational study.
The cerebral oximetry index (COx) uses near-infrared spectroscopy to estimate cerebral autoregulation during cardiac surgery. However, the relationship between intraoperative loss of cerebral autoregulation and postoperative delirium or stroke remains unclear in patients recovering from carotid endarterectomy (CEA). ⋯ COx is a promising metric for predicting postoperative delirium or new-onset overt stroke in patients having CEA. The optimal COx threshold was 0.7 in the pre-clamping phase and 0.4 in the post-clamping phase.
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Observational Study
Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study.
To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children. ⋯ The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV.
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Observational Study
Mitochondrial oxygenation monitoring and acute kidney injury risk in cardiac surgery: A prospective cohort study.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery and is associated with increased morbidity and mortality. Recent guidelines emphasize the need for new monitoring methods to facilitate targeted CSA-AKI prevention and treatment strategies. In vivo real-time measurement of mitochondrial oxygen tension (mitoPO2), could potentially fulfil this role during cardiac surgery, as suggested in our previous pilot study. ⋯ This study highlighted the association between mitoPO2 and the onset of CSA-AKI. Extended durations below the mitoPO2 threshold of 25 mmHg significantly correlate with an elevated CSA-AKI risk. Using mitoPO2 as a monitoring tool shows promise in potentially predicting and possibly preventing CSA-AKI when used as a treatment trigger in cardiac surgery patients.
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Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure. ⋯ Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.
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Residual neuromuscular block (NMB) after anesthesia poses significant risk to patients, which can be reduced by adhering to evidence-based practices for the dosing, monitoring, and reversal of NMB. Incorporation of best practices into routine clinical care remains uneven across providers and institutions, prompting the need for effective implementation strategies. ⋯ This initiative demonstrates successful large-scale integration of quantitative TOF monitoring and evidence based NMB management across a diverse medical center, while highlighting important barriers in implementation. These findings contribute to the broader discussion on translating evidence into practice, offering insights for improving patient care and safety through tailored implementation strategies.