International anesthesiology clinics
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A number of anesthetic agents have significant cerebroprotective potential and alter ischemic tolerance in vivo, at least within specific experimental conditions such as focal or incomplete, global cerebral ischemia. As compared to the unanesthetized state, each of these agents has some influence on CBF and metabolism, and many have significant effects on vascular responses to dilator stimuli. Relevant studies that provide clues to the mechanisms of anesthetic action in brain injury have been reviewed, and it is likely that these mechanisms are multifactorial and may overlap from one class of agents to another. Lastly, there is a clear need for further studies that specifically evaluate the neuroprotective mechanism of each agent, determine the effect on outcomes when the anesthetic is administered only as a posttreatment at clinically relevant concentrations, and compare anesthetics with the unanesthetized state when possible.
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Int Anesthesiol Clin · Jan 1996
ReviewHypothermia-associated protection from ischemic brain injury: implications for patient management.
There is a large amount of experimental evidence that mild hypothermia in laboratory animals will protect the brain from ischemic injury. Conversely, mild hyperthermia will exacerbate injury. Supporting data in humans are limited. ⋯ Second, better methods are needed to monitor brain temperature during periods of risk for ischemic injury. And third, management techniques should be identified that will use brain-to-core temperature gradients to the patient's advantage, thus producing optimal alterations in brain temperature while minimally affecting systemic temperature and physiology. Before these goals can be accomplished, more research is needed, both in laboratory animals and in humans.
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Int Anesthesiol Clin · Jan 1996
ReviewAssessment of sedation, analgesia, and neuromuscular blockade in the perioperative period.
Identification of adequate pain relief, sedation, and neuromuscular blockade in the perioperative period (be it for monitored anesthesia care, conscious sedation, ICU analgesia or sedation, or during intraoperative care) continues to be a challenge. Current subjective and objective techniques have been reviewed. The combination of clinical judgement, physiological response, and selected monitoring tools provide the current standard of care used to optimize patient care and comfort. Future directions in assessing pain control, adequacy of sedation, and degree of neuromuscular blockade include: (1) simplified scoring scales, (2) computerized analysis of the EEG, (3) computerized evoked potentials, (4) portable accelerography of electromyography for determination of neuromuscular blockade, and (5) closed loop system for delivery of analgesics, sedatives, and paralytics.
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Int Anesthesiol Clin · Jan 1996
ReviewMethods for monitoring hemostasis during and following cardiac surgery.
The challenges in cardiac surgical hemostasis continue to plague the clinician. Rapid analysis and interpretation of coagulation tests are crucial in identifying coagulopathies that include both hemorrhagic and thrombophilic conditions. ⋯ The coagulation tests that provide the most useful information include both end-point determinants and kinetic tests of clot formation. Future evaluation of the efficacy of coagulation tests in meeting these challenges will move beyond quantification of changes within various intermediates of hemostasis and rest with the correlation of these measured values with specific, outcome-directed indicators for optimizing patient care.