Articles: cations.
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Anesthesia and analgesia · Oct 2024
Optimal Infusion Rate of Norepinephrine for Prevention of Spinal Hypotension for Cesarean Delivery: A Randomized Controlled Trial, Using Up-Down Sequential Allocation.
Norepinephrine has recently been suggested to be as effective as phenylephrine for the prevention of hypotension after spinal anesthesia for cesarean delivery. Moreover, compared to phenylephrine, norepinephrine may be superior in maintaining heart rate (HR) and consequently, cardiac output (CO). A recent study demonstrated that norepinephrine given as a single intravenous bolus is approximately 13 times more potent than phenylephrine. However, it is uncertain whether this finding can be applied when these vasopressors are administered as infusions. Therefore, the optimum infusion rate of norepinephrine remains unknown. We aimed to determine the median effective dose (ED50; defined as the rate of vasopressor infusion required to prevent spinal hypotension in 50% of subjects) of both drugs needed to maintain maternal systolic blood pressure within 20% of the baseline after spinal anesthesia for cesarean delivery and to derive the relative potency ratio. ⋯ Norepinephrine is more potent than phenylephrine by a factor of approximately 13 when administered as infusion for equivalent maternal blood pressure control. Based on these findings, we recommend a variable rate prophylactic infusion of norepinephrine to be initiated at 1.9 to 3.8 µg.min-1 for the management of hypotension during cesarean delivery under spinal anesthesia.
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First-line therapy for most intracranial dural arteriovenous fistulas (dAVFs) is endovascular embolization, but some require microsurgical ligation due to limited endovascular accessibility, anticipated lower cure rates, or unacceptable risk profiles. We investigated the most common surgically treated dAVF locations and the approaches and outcomes of each. ⋯ Although endovascular embolization is the first-line treatment for most intracranial dAVFs, surgical ligation is an important alternative. ACF and tentorial fistulas particularly demonstrate high rates of postoperative obliteration.
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Anesthesia and analgesia · Oct 2024
Risk of Acute Complications with Rocuronium versus Cisatracurium in Patients with Chronic Kidney Disease: A Propensity-Matched Study.
Neuromuscular blocking agents (NMBAs) play an integral role in modern anesthesia by facilitating endotracheal tube placement, assisting with mechanical ventilation, and creating optimal surgical conditions. However, NMBAs can have deleterious side effects. The purpose of this study was to retrospectively analyze acute complications of 2 pharmacodynamically similar but pharmacokinetically different NMBAs and their respective reversal agents. ⋯ From 2003 to 2023, patients who were administered rocuronium plus sugammadex were at a significantly higher risk for acute cardiovascular and pulmonary complications when compared to patients who were administered cisatracurium plus neostigmine.
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Recent advances in flow diverter (FD) therapy for intracranial aneurysms have highlighted the need to evaluate risk factors for in-stent stenosis (ISS), a potentially serious complication. This meta-analysis aims to identify risk factors associated with an increased risk of ISS after FD treatment. ⋯ This meta-analysis identified both nonmodifiable (younger age, male sex) and modifiable (smoking) patient factors, as well as high-risk aneurysm characteristics (posterior circulation, fusiform, ruptured), associated with an increased risk of ISS after FD treatment. These findings highlight the importance of tailored monitoring and management approaches for optimizing outcomes in FD therapy.
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Traumatic acute subdural hematoma (ASDH) is a medical emergency that requires prompt neurosurgical intervention. Urgent surgical evacuation may be performed with craniotomy (CO) and decompressive craniectomy (DC). However, a meta-analysis evaluating confounders, pooled functional outcomes, and mortality analyses at different time points has not been performed. ⋯ Patients with ASDH undergoing DC across unmatched cohorts had a worse GCS at admission. Although ASDH mortality was lower in the CO group, these findings are derived from unmatched cohorts, potentially confounding previous analyses. Notably, population-matched studies, such as the RESCUE-ASDH trial and PSM cohorts, showed similar effectiveness in mortality and functional outcomes between CO and DC. Reoperation and complication rates were comparable among surgical approaches. Considering the prevalence of unmatched cohorts, our findings highlight the need of future clinical trials to validate the findings of the RESCUE-ASDH trial.