Articles: outcome.
-
The role of nonspecific treatment effects in the outcomes of patients receiving interventions for pain has been the subject of controversy and interest. While the administration of placebo and its effects have been widely studied, the role of placebo and nocebo effects of active agents administered prior to or during interventional techniques has not been explored. ⋯ In patients undergoing interventional procedures, sodium chloride solution, midazolam, and fentanyl produced placebo effects in 13% to 15%, 15% to 20%, and 18% to 30% of the patients respectively. Similarly, a nocebo effect was seen in 5% to 8% of the patients in the sodium chloride group, 8% of the patients in the midazolam group, and 3% to 8% of the patients in the fentanyl group. It is concluded that positive and negative effects may be seen either with placebo or active agents in 13% to 30% of the patients.
-
Myocardial protection defines the set of strategies aiming at attenuating the intensity of myocardial ischemia-reperfusion injury during heart surgery and its harmful consequences on myocardial function. A better understanding of pathophysiological phenomena related to ischemia-reperfusion events and of the anesthetic-induced heart protection has given to the anesthesiologist a major role in intraoperative myocardial protection. The objective of this update was to review the mechanisms of ischemia-reperfusion-induced myocardial injury and myocardial protection modalities focusing on anesthetic techniques. ⋯ The association of adequate anesthetic technique using heart protecting agents to usual myocardial protection modalities performed by the surgeon may contribute to the prevention of cardiac surgery-induced myocardial dysfunction and improve postoperative outcome.
-
The National Institutes of Health Stroke Scale (NIHSS) score is known to be effective in predicting the likelihood of recovery after stroke. However, the baseline NIHSS score predicts long-term outcomes rather crudely because early changes in stroke scores may influence the stroke outcomes. Therefore, a precise prognostic algorithm or a cutoff point for predicting long-term outcomes based on data from serial NIHSS scores is needed. ⋯ An NIHSS score of at least 6 on day 7 after admission accurately forecasts a poor long-term outcome after stroke. Our data may be helpful in predicting the long-term prognosis as well as in making decisions regarding novel therapeutic applications in subacute-stroke trials.
-
Epidural blood patches (EBPs) usually afford rapid and successful treatment outcomes for postdural puncture headaches (PDPH) with few adverse sequelae. ⋯ Epidural blood patches for the management of PDPH, especially PDPH associated with CN palsies, should be administered as soon as the diagnosis of PDPH is made with lower volumes of autologous blood (< or =20 mL) to assure the best treatment outcomes.
-
Intracerebral haemorrhage (ICH) is much less common than ischaemic stroke (15% versus 85% in most Western studies), but is associated with a significantly worse prognosis. ICH is much more common in Asian populations, probably reflecting higher rates of small vessel disease, hypertension and genetic factors. Overall, ICH mortality rates approach 50% and there has been little effective treatment to date, except for the overall benefit from stroke unit care. ⋯ Medical therapies to reduce brain edema and intracranial pressure, including glycerol and mannitol, are not of proven value. It is accepted that corticosteroids should not be used in ICH and may worsen outcomes. The management of acute hypertension is controversial and guidelines are based on little direct evidence.