Articles: function.
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Anesthesia and analgesia · Feb 2014
Emulsified isoflurane increases convulsive thresholds of lidocaine and produces neural protection after convulsion in rats.
Local anesthetic-induced convulsions remain a concern of anesthesiologists when performing regional anesthesia. Our previous study found that the lidocaine requirement for IV regional anesthesia was reduced with coadministration of emulsified isoflurane. We designed this study to examine whether emulsified isoflurane could increase the convulsive threshold of lidocaine and produce protection after a lidocaine-induced convulsion. ⋯ Emulsified isoflurane increased the convulsive threshold of lidocaine and preserved neurological function in rats experiencing lidocaine-induced convulsions.
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Pulmonary hypertension is defined as a resting mean pulmonary arterial pressure of 25 mm Hg or more determined at right heart catheterization. The challenges for imaging in patients with suspected PH are fivefold: the imaging modality should have a high diagnostic accuracy with regard to the presence of PH; it should be able to characterize the underlying disease, and allow for quantification of its extent by measuring pulmonary hemodynamics. Finally, it should provide prognostic information, and can be used for monitoring of therapy. ⋯ MR imaging is the reference standard for assessment of cardiac structure and function and allows for physiologic assessment of the pulmonary vasculature. New developments show that with MR techniques, an estimation of hemodynamic parameters such as mean pulmonary arterial pressure and pulmonary vascular resistance will be possible. Actually, CT and MR imaging should be considered as complementary investigations providing comprehensive information in patients with pulmonary hypertension.
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Curr Opin Anaesthesiol · Feb 2014
ReviewUpdate on minimally invasive hemodynamic monitoring in thoracic anesthesia.
Advanced hemodynamic monitoring is indispensable for adequate management of patients undergoing major surgery. This article will summarize minimally invasive hemodynamic monitoring technologies and their potential use in thoracic anesthesia. ⋯ Many different minimally invasive hemodynamic monitoring devices have been developed and clinically introduced in the last years. They offer the advantage of being less invasive and easier to use. However, these techniques have several limitations and data are scarce in patients undergoing thoracic anesthesia, preventing their widespread use so far.
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Curr Opin Anaesthesiol · Feb 2014
ReviewCerebral protection: inflammation, endothelial dysfunction, and postoperative cognitive dysfunction.
Postoperative cognitive dysfunction (POCD) is a well recognized perioperative syndrome, with approximately 15% of patients over the age of 60 years displaying objectively measured decrease in cognitive function as a consequence of anesthesia and surgery. The exact cause, however, remains unknown. This review aims to update anesthesiologists on the recent advancements in the understanding of the pathophysiology of POCD. ⋯ Recent research points to a central role of a neuro-inflammatory cascade in POCD, with endothelial dysfunction potentially aggravating the insult. Investigating the genomic and molecular mechanisms that underlie the intervariation in the inflammatory response to surgery, improving the identification of appropriate endothelial and inflammatory biomarkers, and developing endothelial modulatory and anti-inflammatory (prevention and resolution) strategies are key areas of future translational research. This is important as the elderly, who show increased susceptibility to this and other perioperative illness syndromes, represent an ever-increasing proportion of patients presenting for surgery.
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This article reviews the current diagnostic strategies for patients with suspected pulmonary embolism (PE) focusing on the current first choice imaging modality, computed tomographic pulmonary angiography (CTPA). Diagnostic strengths and weaknesses and associated cost-effectiveness of the diagnostic pathways will be discussed. The radiation dose risk of these pathways will be described and techniques to minimize dose will be reviewed. ⋯ Although current cost-effectiveness evaluations have established CT as integral in the PE diagnostic pathway, failure to acknowledge the impact of alternate diagnosis represents a current knowledge gap. The emerging dual energy capacity of current CT scanners offers the potential to evaluate both pulmonary vascular morphology and ventilation perfusion relationships within the lung parenchyma at high spatial resolution. This dual assessment of lung morphology and lung function at low (< 5 millisievert) radiation dose represents a substantial advance in PE imaging.