Articles: function.
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Anesthesia and analgesia · Nov 2014
Randomized Controlled Trial Comparative StudySurgical Space Conditions During Low-Pressure Laparoscopic Cholecystectomy with Deep Versus Moderate Neuromuscular Blockade: A Randomized Clinical Study.
Laparoscopic cholecystectomy performed during low intraabdominal pressure (<12 mm Hg) is associated with significantly less postoperative pain than standard pressure (≥12 mm Hg). The impact on surgical space conditions and safety of operating at lower pressures has not been adequately described, but deep neuromuscular blockade may be beneficial. We investigated if deep muscle relaxation would be associated with a higher proportion of procedures with "optimal" surgical space conditions compared with moderate relaxation during low-pressure (8 mm Hg) laparoscopic cholecystectomy. ⋯ Deep neuromuscular blockade was associated with surgical space conditions that were marginally better than with moderate muscle relaxation during low-pressure laparoscopic cholecystectomy.
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In functional imaging studies, the insular cortex (IC) has been identified as an essential part of the processing of a whole spectrum of multimodal sensory input. However, there are no lesion studies including a sufficient number of patients, which would reinforce the functional imaging data obtained from healthy subjects. Such lesion studies should examine how damage to the IC affects sensory perception. We chose acute stroke patients with lesions affecting the IC in order to fill this gap. ⋯ Our data allow the conclusion that the posterior IC may represent the major region responsible for encoding warm and cold perception in the brain. To what extent focal IC lesions may also impair pain processing or induce post-stroke pain has to be addressed in future studies including more patients.
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Propionic acidemia is a congenital disorder of metabolism where the enzyme propionyl-CoA carboxylase is nonfunctional, resulting in an accumulation of propionic acid in the blood. It is important to avoid excess protein intake and a catabolic state to prevent acidemia. Additionally, it may be wise to avoid anesthetic drugs metabolized by propionyl-CoA carboxylase because use of these drugs may lead to acidosis. We present a case of a parturient with propionic acidemia who presented for induction of labor.
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Anesthesia and analgesia · Nov 2014
Observational StudyMeasured Versus Predicted Blood Propofol Concentrations in Children During Scoliosis Surgery.
Propofol anesthesia is preferred during scoliosis surgery because it suppresses evoked potential spinal cord function less than other drugs and better enables the detection of spinal cord ischemia. In this study, we determined the difference between the true and predicted blood propofol levels during target-controlled infusions in children during scoliosis surgery. ⋯ Propofol target-controlled infusion models had poor performance characteristics in children undergoing scoliosis surgery. Point-of-care propofol assay may enable adjustment of the infusion to better achieve the intended blood level.
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Critical care medicine · Nov 2014
Comparative StudyPower and Limitations of Daily Prognostications of Death in the Medical ICU for Outcomes in the Following 6 Months.
We tested the power of clinicians' predictions that a medical ICU patient would "die before hospital discharge" for both survival to discharge and for outcomes at 6 months. ⋯ Fewer than 4% of medical ICU patients who required 72 hours of medical ICU care and had a corroborated prediction of death before discharge were alive at 6 months and functioning with a Barthel score more than 70.