AANA journal
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Guidelines for the perioperative administration of fluid are often based on static hemodynamic targets such as central venous pressure, and delayed volume status indexes such as blood pressure, heart rate, capillary refill, and urine output. Traditional fluid management protocols also rely heavily on algorithmic estimates of fluid deficit, intravascular fluid volume status, fluid loss, and basal fluid requirements to guide perioperative fluid administration. Such formulaic approaches lack definitive physiologic endpoints for determining fluid optimization and fail to address the roles of tissue oxygenation and end-organ perfusion in achieving positive long-term patient outcomes. ⋯ A broad literature search was conducted, and 12 studies met the inclusion criteria. Studies were evaluated for design, population, goal-directed therapy targets, monitoring devices used, clinical endpoints, methods, and results. Goal-directed therapy was associated with decreased hospital stay compared with the control group (in 7 studies) and reduced number of postoperative complications (7 studies).
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Review Meta Analysis Comparative Study
To press or not to press, and if so, with what? A single question-focused meta-analysis of vasopressor choice during regional anesthesia in obstetrics.
Given the underlying assumption that reasonable maternal hemodynamics can be achieved with either ephedrine or phenylephrine, this focused meta-analysis addresses the impact of vasopressor choice on resultant neonatal Apgar scores during regional anesthesia. The literature was systematically searched for randomized trials of obstetric vasopressor use employing standard search tools. Only the highest quality trials were included. ⋯ Apgar scores at 1 and 5 minutes in the ephedrine group (served as control) vs the phenylephrine group did not differ at either time epoch; no abnormal values prevailed in either group (relative risk, 0.88; CI, 0.79-1.16). This meta-analysis focused on the most clinically relevant, immediately available information pertinent in the obstetric suite, the Apgar score, and found that ephedrine and phenylephrine did not differ in their effect on this metric. The current meta-analysis provides an updated, evidence-based validation of vasopressor use from the American Society of Anesthesiologists' 2007 "Practice Guidelines for Obstetric Anesthesia".
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Review Case Reports
Methylene blue encephalopathy: a case report and review of published cases.
Methylene blue is a cationic thiazine dye useful in staining parathyroid glands during surgical resection. There have been a number of reports of altered neurologic status postoperatively in patients who are taking antidepressant medications when they received methylene blue for their surgery. ⋯ It has been suggested that in susceptible individuals an interaction occurs between methylene blue and serotonergic agents that precipitates serotonin syndrome. Because people with hyperparathyroidism commonly experience depression as part of their illness, anesthesia practitioners should exercise increased vigilance when administering methylene blue to these patients.
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Review Case Reports
Unilateral hypoglossal neurapraxia following endotracheal intubation for total shoulder arthroplasty.
A case is described of postoperative right hypoglossal neurapraxia after general anesthesia and interscalene block with endotracheal intubation for left total shoulder arthroplasty. Postoperative hypoglossal neurapraxia has been reported in cases, yet it remains a rare complication of anesthesia-related interventions. ⋯ Anesthesia providers should be aware of the course of cranial nerve XII as it relates to the position of the head and neck and use of airway instrumentation. In suspected cases of hypoglossal neurapraxia, conservative therapeutic interventions may be warranted.
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General anesthesia is known to cause pulmonary atelectasis; in turn, atelectasis increases shunt, decreases compliance, and may lead to perioperative hypoxemia. One mechanism for the formation of atelectasis intraoperatively is ventilation with 100% oxygen. The goal of this review is to determine if research suggests that intraoperative ventilation with 100% oxygen leads to clinically significant pulmonary side effects. ⋯ From this body of research, it appears that absorption atelectasis does occur in healthy anesthetized adults breathing 100% oxygen. Data reviewed suggest that absorption atelectasis does not have significant clinical implications in healthy adults. However, further research is warranted in populations at increased risk of postoperative hypoxemia, including obese or elderly patients and those with preexisting cardiopulmonary disease.