Articles: function.
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Minerva anestesiologica · Jun 2016
Cardiac dysfunction and circulating cardiac markers during sepsis.
Among several alterations affecting the cardiovascular system during severe sepsis or septic shock, myocardial depression has been pointed out with increasing attention over the last 30 years as a frequent and often misdiagnosed clinical condition. As expected, patients with cardiac dysfunction during sepsis have a worse prognosis than those without. In the present review, we will first discuss the etiology, pathophysiology, monitoring and clinical manifestations of cardiac dysfunction in patients with severe sepsis or septic shock. ⋯ We will focus on two specific markers of cardiac origin: troponins, which reveal cardiac myocytes injury, and natriuretic peptides, as indicators of cardiac chambers wall stress and fluid homeostasis. The bulk of evidences accumulated so far on cardiac markers support their role as prognostic indicators, with marginal improvement in terms of accuracy, as compared to widely employed clinical scores. Their potential to satisfy unmet needs in the daily care of septic patients is more appealing, in particular for monitoring the cardiovascular system during support therapy.
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Plasticity in inhibitory receptors, neurotransmission, and networks is an important mechanism for nociceptive signal amplification in the spinal dorsal horn. We studied potential changes in GABAergic pharmacology and its underlying mechanisms in hyperalgesic priming, a model of the transition from acute to chronic pain. We find that while GABAA agonists and positive allosteric modulators reduce mechanical hypersensitivity to an acute insult, they fail to do so during the maintenance phase of hyperalgesic priming. ⋯ Neurolide 2 treatment also reverses the change in polarity in GABAergic pharmacology observed in the maintenance of hyperalgesic priming. We propose that increased nlgn2 expression is associated with hyperalgesic priming where it promotes dysregulation of inhibitory networks. Our observations reveal new mechanisms involved in the spinal maintenance of a pain plasticity and further suggest that disinhibitory mechanisms are central features of neuroplasticity in the spinal dorsal horn.
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The purpose of this case report is to describe the anesthetic and case management of the first vascularized composite allograft pediatric bilateral hand transplant. ⋯ This report describes the anesthetic management of the first pediatric bilateral hand transplant. This procedure required considerable preoperative planning and communication between various teams to ensure all resources needed to deliver the care for this complex and novel transplant surgery were readily available.
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In recent years, the treatment options for patients with severe cardiorespiratory failure have been extended by the implementation of mechanical circulatory support (MCS). Identification of patients that benefit most from this cost-intensive treatment modality is of central importance, but is also challenging. Previous studies unravelled certain patient characteristics that should be taken into account, such as age, weight, and underlying pathology, and also the delay until MCS implementation as well as tissue hypoxia as prognostic factors. ⋯ Of note, baseline liver function tests predicted outcome in patients on extracorporeal life support (ECLS), including short-term and long-term mortality. Most strikingly, increased levels of alkaline phosphatase and total bilirubin indicated unfavourable short-term and long-term survival even after adjustment for age, gender, left ventricular function, and relevant known comorbidities such as impaired renal function and diabetes. Therefore, the assessment of liver function tests may be regarded as another piece in the complex puzzle of our efforts perceiving the ideal ECLS candidate with positive long-term outcome.