Articles: function.
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Minerva anestesiologica · Nov 2022
Understanding left ventricular diastolic dysfunction in anesthesia and intensive care patients: "a glass with progressive shape change".
Left ventricular (LV) diastolic dysfunction is a commonly encountered condition and its impact on the anesthesia and the intensive care population is often underestimated. The study of the diastole is known as "diastology" and comprises four phases: isovolumetric relaxation, early filling phase, diastasis, and late filling phase. Diastolic function needs at least the same attention as systolic function, since its alteration has been associated with worse prognosis. ⋯ First, we use a metaphor to consider the LV as a glass that progressively changes its shape and height along the disease course, resembling variable end-diastolic pressures and volumes at different stages while progressing with diastolic dysfunction. We guide readers in the process of diagnosis and grading of LV diastolic dysfunction, with description of pathophysiological changes in LV relaxation and consequently in the pressure gradient between the left-sided heart chambers. In the second part, starting from physiology we move towards suggestions for the clinical management of anesthesia and intensive care patients with diastolic dysfunction under different scenarios (hypo- and hypervolemia, weaning, sepsis, tachycardia and arrhythmias, right ventricular dysfunction).
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Fischer U, Kaesmacher J, Strbian D, et al. Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet. 2022;400:104-15. 35810756.
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Gallbladder dyskinesia is a functional disorder of the gastrointestinal tract, which can result in debilitating episodes of abdominal pain and associated symptoms. Key diagnostic criteria include a diminished gallbladder ejection fraction on scintigraphy and absence of other causes for the symptoms. ⋯ Patients meeting the clinical and diagnostic criteria for gallbladder dyskinesia should be referred for cholecystectomy, and most of these patients will have relief of their symptoms. A comprehensive preoperative discussion on expected outcomes needs to take place.