Articles: function.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Acute intraoperative heart failure].
With respect to the fact that - with the notable exception of patients undergoing cardiac surgery - only sparse data and limited guideline recommendations on optimal treatment strategies in patients with intraoperative acute heart failure are available. Consecutively it is rather difficult to make clear suggestions for the optimal treatment of this complication. ⋯ Importantly, one has to to take into account that the use of beta-mimetic drugs for the treatment of acute heart failure is increasingly recognized as an isolated mortality factor. This suggests to use inotropes as restrictive as possible, and if inotropic treatment becomes inevitable, to use levosimendan as the only inotrope that has been shown to improve mortality in several meta-analyses.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Anesthetic management and monitoring].
Due to the demographic and medical development, the number of patients with heart failure needing anaesthesiological care will continue to grow in the upcoming years. For the optimal care of these patients close coordination between the surgically treating, the cardiology and the anesthesiological department is important. Cardiac function and structural characters, such as cardiac valve defects should be known preoperatively. ⋯ Especially in high-risk patients goal directed hemodynamic therapy is useful. For this, in addition to the established monitoring procedures, less invasive monitoring devices areincreasingly used. During an acutehaemodynamic instability, thetransoesophageal echocardiography is gaining importance due to its wide diagnostic evaluation.
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Observational Study
Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study.
ICU-acquired weakness is thought to mediate physical impairments in survivors of critical illness, but few studies have investigated this thoroughly. The purpose was to investigate differences in post-ICU mortality and physical functioning between patients with and without ICU-acquired weakness at 6 months after ICU discharge. ⋯ ICU-acquired weakness is independently associated with higher post-ICU mortality and with clinically relevant lower physical functioning in survivors at 6 months after ICU discharge.
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Transient receptor potential (TRP) channels are nonselective cation channels expressed in a variety of sensory structures, and are important molecular mediators of thermal, mechanical, cellular and chemical signals. We investigated the function of one key member of the TRP superfamily, TRPA1, in the spinal dorsal horn using in vivo patch-clamp recordings. ⋯ TRPA1 appears to be localized not only at presynaptic terminals on SG neurons, enhancing glutamate release, but also in the terminals of primary afferents innervating spinal inhibitory interneurons, which have synaptic interactions with SG neurons. This study offers further insight into the mechanisms underlying the possible antinociceptive actions of TRPA1 activation in the spinal dorsal horn. Our findings suggest that pharmacological activation of spinal TRPA1 channels may have therapeutic potential for the treatment of pain.