Journal of anesthesia
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Journal of anesthesia · Apr 2017
Randomized Controlled TrialHyperinsulinemic normoglycemia decreases glucose variability during cardiac surgery.
Increased glucose variability may be associated with worse outcomes in critically ill patients. Hyperinsulinemic normoglycemia provides intensive glucose control during surgery and may reduce glucose variability. Our objective was to compare glycemic variability between two methods of glucose control in cardiac surgical patients: hyperinsulinemic normoglycemia vs standard insulin infusion. We also assessed whether the effect differed between patients with and without diabetes mellitus. ⋯ Hyperinsulinemic normoglycemia decreases glucose variability for cardiac surgical patients with a stronger effect in nondiabetic patients.
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Journal of anesthesia · Apr 2017
Controlled Clinical TrialSelective induction of IL-1β after a brief isoflurane anesthetic in children undergoing MRI examination.
To determine if isoflurane anesthesia without surgery causes systemic inflammation in children. Inflammation is targeted as responsible for the development of many neurologic pathologies. The effect will be evaluated by measuring serum cytokine levels before and after isoflurane anesthesia. The possible neurotoxic effect of anesthetic agents is a concern in pediatric anesthesia. Questions remain as to the true effects of anesthesia alone on systemic inflammation. The current study assesses systemic inflammatory response to general anesthesia in children not exposed to surgical stress. ⋯ A brief (approximately 60 min) exposure to isoflurane general anesthesia, without induced surgical stress, significantly increased serum IL-1β, a selective activation marker of systemic inflammation (IL-1β pathway).
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Journal of anesthesia · Apr 2017
The impact of liver disorders on perioperative management of reoperative cardiac surgery: a retrospective study in adult congenital heart disease patients.
We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients. ⋯ ACHD patients who underwent reoperative cardiac surgery had a high prevalence of risk factors for liver disorders preoperatively, and liver disorders aggravated some intraoperative outcomes. These findings suggest that the prevention of liver disorders is important for reducing the occurrence of poor outcomes, and that ACHD patients with liver disorders need attentive perioperative management.
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There is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly at the end of anesthesia, predicting postoperative mortality. ⋯ The sAs and ASA-PS were shown to be extremely useful for predicting 30-day mortality after surgery. An even higher predictive ability was demonstrated by the SASA, which combines these simple and effective scoring systems.