Articles: cations.
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The anterior communicating artery (AcoA) is the most common location for intracranial aneurysms. ⋯ Coiling with and without stent/balloon assistance is a relatively safe and effective modality for the treatment of AcoA aneurysms; however, in the setting of recurrence, microsurgical reconstruction leads to improved outcomes regarding durable occlusion, thus avoiding the potential for multiple interventions in the future.
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Acta Anaesthesiol Scand · May 2022
Multicenter StudyImproving neuromuscular monitoring and reducing residual neuromuscular blockade via e-learning - a multicentre interrupted time-series study (INVERT study).
Neuromuscular monitoring should be applied routinely to avoid residual neuromuscular block. However, anaesthetists often refrain from applying it, even when the equipment is available. We aimed to increase neuromuscular monitoring in six Danish anaesthesia departments via e-learning. ⋯ We found no overall effect of the e-learning module on application of neuromuscular monitoring, although the post-course test indicated an effect on anaesthetists' knowledge in this field.
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Acta Anaesthesiol Scand · May 2022
Online Exhaled Propofol Monitoring in Normal-weight and Obese Surgical Patients.
Ion mobility spectrometry (IMS) allows for online quantification of exhaled propofol concentrations. We aimed to validate a bedside online IMS device, the Edmon® , for predicting plasma concentrations of propofol in normal-weight and obese patients. ⋯ Online monitoring of exhaled propofol concentrations is clinically feasible in normal-weight and obese patients. With a 5-min delay, our model outperforms the Marsh plasma TCI model in a post hoc analysis. Modest correlation with plasma concentrations makes the clinical usefulness questionable.
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Anesthesia and analgesia · May 2022
Future of Perioperative Precision Medicine: Integration of Molecular Science, Dynamic Health Care Informatics, and Implementation of Predictive Pathways in Real Time.
Conceptually, precision medicine is a deep dive to discover disease origin at the molecular or genetic level, thus providing insights that allow clinicians to design corresponding individualized patient therapies. We know that a disease state is created by not only certain molecular derangements but also a biologic milieu promoting the expression of such derangements. These factors together lead to manifested symptoms. ⋯ Precision medicine is gaining ground with the help of personalized health recorders and personal devices that identify disease mechanics, patient-reported outcomes, adverse drug reactions, and drug-drug interaction at the individual level in a closed-loop feedback system. This phenomenon is especially true given increasing surgeries in older adults, many of whom are on multiple medications and varyingly frail. In this era of precision medicine, to provide a comprehensive remedy, the perioperative surgical home must expand, incorporating not only clinicians but also basic science experts and data scientists.