Articles: cations.
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Introduction: Perioperative alterations in perfusion lead to ischemia and reperfusion injury, and supplemental oxygen is administered during surgery to limit hypoxic injury but can lead to hyperoxia. We hypothesized that hyperoxia impairs endothelium-dependent and endothelium-independent vasodilation but not the vasodilatory response to heme-independent soluble guanylyl cyclase activation. Methods: We measured the effect of oxygen on vascular reactivity in mouse aortas. ⋯ Aorta 2-hydroxyethidium was 1419 pmol/mg of protein (25th-75th percentile = 1178-1513) in normoxia, 1993 (1831-2473) in moderate hyperoxia, and 2078 (1936-2922) in severe hyperoxia ( P = 0.008, effect across groups). Conclusions: Hyperoxia, compared with normoxia, impaired endothelium-dependent and endothelium-independent vasodilation but not the response to heme-independent soluble guanylyl cyclase activation, and hyperoxia increased vascular superoxide production. Results from this study could have important implications for patients receiving high concentrations of oxygen and at risk for ischemia reperfusion-mediated organ injury.
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Cerebrospinal fluid tap test is a common procedure to predict the efficacy of ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus. Objective tests after cerebrospinal fluid tap test are used to establish the surgical indication, but subjective improvements may also be important in selection of surgical candidates. The aim of this study was to evaluate surgical outcomes of patients with ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus, comparing patients showing objective improvement with patients improving only on subjective assessments. ⋯ Surgical outcomes after ventriculoperitoneal shunt were similar between the 2 groups, with a more favorable trend in terms of symptom improvement for subjective responders. Subjective assessment seems to be an important factor to consider in preoperative evaluation.
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Curr Opin Anaesthesiol · Oct 2022
Review Meta AnalysisSalted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension.
The aim of this review article is to present current recommendations regarding the use of hypertonic saline and mannitol for the treatment of intracranial hypertension. ⋯ Identifying and treating increased intracranial pressure is imperative in neurocritical care settings and proper management is essential to improve long-term outcomes. Currently, there is insufficient evidence from comparative studies to support a formal recommendation on the use of any specific hyperosmolar medication in patients with acute increased intracranial pressure.
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Minerva anestesiologica · Oct 2022
Meta AnalysisA systematic review and meta-analysis of three risk factors for chronic postsurgical pain: age, sex and preoperative pain.
Chronic postsurgical pain (CPSP) is a common and disabling postoperative complication. Several risk factors for CPSP have been established, but it is unclear whether they are significant for any type of surgery. This systematic review aimed to assess the risk of CPSP related to three known preoperative risk factors "age, sex and preoperative pain" in the adult population after any type of elective non-obstetrical surgery. ⋯ This systematic review confirms that younger age, female sex, and preoperative pain are associated with higher risk of developing CPSP in any type of elective non-obstetrical surgery. However, effect sizes are small and quality of evidence low-moderate only, limiting comparisons of different types of surgery.