Randomized Controlled Trial
Mild brain hypothermia (32°-34°C) after human neonatal asphyxia improves neurodevelopmental outcomes. Astrocytes but not neurons have pyruvate carboxylase and an acetate uptake transporter. C nuclear magnetic resonance spectroscopy of rodent brain extracts after administering [1-C]glucose and [1,2-C]acetate can distinguish metabolic differences between glia and neurons, and tricarboxylic acid cycle entry via pyruvate dehydrogenase and pyruvate carboxylase. ⋯ Starting mild hypothermia simultaneously with oxygen-glucose deprivation, compared with delayed starting or no hypothermia, has higher pyruvate carboxylase throughput, suggesting that better glial integrity is one important neuroprotection mechanism of earlier hypothermia.
The objective was to determine the effect of apneic oxygenation (AP OX) on first pass success without hypoxemia (FPS-H) in adult patients undergoing rapid sequence intubation (RSI) in the emergency department (ED). ⋯ The use of AP OX during the RSI of adult patients in the ED was associated with a significant increase in FPS-H. These results suggest that the use of AP OX has the potential to increase the safety of RSI in the ED by reducing the number of intubation attempts and the incidence of hypoxemia.
This follow-up paper to Hawkin's original "Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990" showed a dramatic improvement in the relative risk of cesarean section death with general vs regional anesthesia compared with the original 1979-1990.
Where previously (1979-1990) the relative risk of death during GA CS was 16.7, from 1997-2002 the relative risk had fallen to 1.7. Worryingly though this was both due to a falling mortality rate for GA CS and an increasing mortality rate for regional anesthesia CS.
Cesarean section under general anesthesia still exposes mothers to an increased risk of perioperative death, but this risk is much lower than previously, likely due to better anesthesia training, supervision and respect of the obstetric airway.summary
Randomized Controlled Trial Multicenter Study Clinical Trial