Journal of clinical anesthesia
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Review Case Reports
Perioperative atrial fibrillation and epidural anesthesia: case report and review of the literature.
A case of new-onset atrial fibrillation subsequent to activation of neuraxial anesthesia is presented. The development of atrial fibrillation was temporally related to placement and dosing of an epidural catheter, and may have been triggered by a vagal response to dosing of the anesthetic or the resulting treatment with fluid and an adrenergic agent. The literature on the acute preoperative management of atrial fibrillation and the implications of atrial fibrillation for the patient undergoing regional anesthesia are reviewed.
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Review
Perspectives on transdermal scopolamine for the treatment of postoperative nausea and vomiting.
Transdermal scopolamine, a patch system that delivers 1.5 mg of scopolamine gradually over 72 hours following an initial bolus, was approved in the United States in 2001 for the prevention of postoperative nausea and vomiting (PONV) in adults. Scopolamine (hyoscine) is a selective competitive anatagonist of muscarinic cholinergic receptors. Low serum concentrations of scopolamine produce an antiemetic effect. Transdermal scopolamine is effective in preventing PONV versus placebo [relative risk (RR)=0.77, 95% confidence interval (CI), 0.61-0.98, P = 0.03] and a significantly reduced risk for postoperative nausea (RR=0.59, 95% CI, 0.48-0.73, P < 0.001), postoperative vomiting (RR=0.68, 95% CI, 0.61-0.76, P < 0.001), and PONV (RR 0.73, 95% CI, 0.60-0.88, P = 001) in the first 24 hours after the start of anesthesia.
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Traditional hemodynamic monitors such as pulmonary artery and central venous catheters provide continuous data and secure intravenous access, but their diagnostic efficacy has been criticized. Dynamic arterial waveform monitoring is promising, but studies suggest it is reliable only within narrow ventilation and rhythm parameters. ⋯ Recent efficacy data, along with other important clinical findings, are reviewed with regard to invasive monitors. We caution against over-generalizing from existing studies, and provide guidance for clinicians wishing to target monitoring techniques for appropriate patients.
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Review Meta Analysis Comparative Study
Meta-analysis of the effect of central neuraxial regional anesthesia compared with general anesthesia on postoperative natural killer T lymphocyte function.
To compare the effect of central neuraxial (spinal or epidural) anesthesia with general anesthesia on postoperative natural killer (NK) T lymphocyte function. ⋯ Anesthetic technique does not appear to significantly affect postoperative NK T lymphocyte function. Given the heterogeneity observed, further clinical studies in cancer patients of the effect of anesthetic technique on immune function in general, and NK T lymphocyte function in particular, are needed.
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There is rapidly increasing prevalence of obesity throughout Western societies and increasing numbers of patients undergoing surgery are obese. Obesity is a condition of chronic systemic inflammation and is associated with an increased burden of comorbidities. Despite traditional teaching, obesity may not be an independent risk factor for poor postoperative outcomes. The Obesity Paradox describes the observation that small amounts of excess body fat may be protective against postoperative complications.