Articles: function.
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Critical care medicine · Dec 2014
Individualized early goal-directed therapy in systemic inflammation: is full utilization of preload reserve the optimal strategy?
In severe acute pancreatitis, the administration of fluids in the presence of positive fluid responsiveness is associated with better outcome when compared to guiding therapy on central venous pressure. We compared the effects of such consequent maximization of stroke volume index with a regime using individual values of stroke volume index assessed prior to severe acute pancreatitis induction as therapeutic hemodynamic goals. ⋯ Individualized optimization of intravascular fluid status during the early course of severe acute pancreatitis, compared with a treatment strategy of maximizing stroke volume by fluid loading, leads to less vascular endothelial damage, pancreatic edema, and inflammatory response.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2014
Review[Pitfalls of anesthesiologic management in operative or interventional securing of aneurysm].
Despite significant advances in operative, interventional and perioperative management aneurysmal subarachnoid hemorrhage is still associated with high rates of 30-day mortality in 35% and severe impairments in neurologic functional outcomes in up to 50% of the survivors. Apart from severity of initial brain injury prognosis depends on the extent of secondary brain injury triggered by re-rupture, vasospasm, hydrocephalus and/ or further operative, interventional or intensive-care associated complications. Due to the complexity of disease the paper exclusively deals with pitfalls of anesthesiologic management in operative and non-operative aneurysm repair.
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Journal of anesthesia · Dec 2014
Randomized Controlled Trial Comparative StudyComparison of cognitive, ambulatory, and psychomotor recovery profiles after day care anesthesia with propofol and sevoflurane.
We compared the recovery profile of propofol and sevoflurane when used for maintenance of anesthesia in elective day care operative procedures. ⋯ Recovery from sevoflurane anesthesia, especially with regard to cognitive functions, may be slightly faster than from propofol, but the difference is not sufficiently significant to affect the time to "home-readiness" in patients undergoing day care surgery.
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Journal of anesthesia · Dec 2014
Pharmacokinetics of sevoflurane elimination from respiratory gas and blood after coronary artery bypass grafting surgery.
Sevoflurane, with a relative low blood-gas partition coefficient, is an ideal anesthetic to achieve rapid offset and recovery from general anesthesia. This study will determine the profiles of four concentration-time curves to characterize the pharmacokinetics of sevoflurane elimination. ⋯ During elimination, the initial washout of sevoflurane from the functional residual capacity of the lungs was reflected in the fast component of the CEsev, Jsev, Asev, and PAsev time curves. In contrast, the slow component was dominated by the tangible effects of the physiological membrane barriers, such as the alveoli-pulmonary capillary and blood-brain barriers.
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Journal of anesthesia · Dec 2014
Case ReportsAnesthetic management of pulmonary valve replacement for pulmonary regurgitation in six patients with surgically repaired tetralogy of Fallot.
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD) encountered in CHD patients surviving into adulthood. A number of patients with surgically repaired TOF have significant pulmonary regurgitation (PR) that can lead to right ventricular (RV) dilatation, RV failure, and arrhythmia. We describe the anesthetic management for pulmonary valve replacement (PVR) in six PR patients with surgically repaired TOF. ⋯ Anesthesiologists should be aware of the multiplicity of comorbidities, sequelae, and residua in patients with surgically repaired TOF. RV function should be monitored using transesophageal echocardiography, and inotropic vasodilators and alpha-adrenergic agents should be administered, as appropriate. Arrhythmias, vascular injury during removal of adhesions during re-sternotomy, and bleeding from collateral vessels are also frequent complications.