Anesthesiology
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Maternal Mortality Surveillance has been conducted by the State of Michigan since 1950, and anesthesia-related maternal deaths were most recently reviewed for the years 1972-1984. ⋯ The 8 anesthesia-related and seven anesthesia-contributing maternal deaths in Michigan between 1985 and 2003 illustrate three key points. First, all anesthesia-related deaths from airway obstruction or hypoventilation took place during emergence and recovery, not during the induction of general anesthesia. Second, system errors played a role in the majority of cases. Of concern, lapses in postoperative monitoring and inadequate supervision by an anesthesiologist seemed to contribute to more than half of the deaths. Finally, this report confirms previous work that obesity and African-American race are important risk factors for anesthesia-related maternal mortality.
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Clinical Trial
Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict fluid responsiveness in the operating room.
Respiratory variations in pulse oximetry plethysmographic waveform amplitude (DeltaPOP) are related to respiratory variations in pulse pressure (DeltaPP) and are sensitive to changes in preload. The authors hypothesized that DeltaPOP can predict fluid responsiveness in mechanically ventilated patients during general anesthesia. ⋯ DeltaPOP can predict fluid responsiveness noninvasively in mechanically ventilated patients during general anesthesia. This index has potential clinical applications.
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Preoperative N-terminal pro-BNP (NT-proBNP) is independently associated with adverse cardiac outcome but does not anticipate the dynamic consequences of anesthesia and surgery. The authors hypothesized that a single postoperative NT-proBNP level provides additional prognostic information for in-hospital and late cardiac events. ⋯ A single postoperative NT-proBNP determination provides important additional prognostic information to preoperative levels and may support therapeutic decisions to prevent subsequent structural myocardial damage.
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Gabapentin administration into the brain of mice reduces nerve injury-induced hypersensitivity and is blocked by intrathecal atropine and enhanced by intrathecal neostigmine. The authors tested the relevance of these findings to oral therapy by examining the efficacy of oral gabapentin to reduce hypersensitivity after nerve injury in rats and its interaction with the clinically used cholinesterase inhibitor, donepezil. ⋯ Although gabapentin may relieve neuropathic pain by actions at many sites, these results suggest that its actions in the brain to cause spinal cholinergic activation predominate after oral administration. Side effects, particularly nausea, cannot be accurately determined on rats. Nevertheless, oral donepezil is well tolerated by patients in the treatment of Alzheimer dementia, and the current study provides the rationale for clinical study of combination of gabapentin and donepezil to treat neuropathic pain.
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Propofol infusion syndrome is first manifest by unexplained metabolic acidosis. Its incidence is unknown. ⋯ This is the first incidence estimate of metabolic acidosis during prolonged propofol infusion and suggests that it is not rare. The study is limited by its retrospective nature and by the lack of baseline arterial blood gas data and will require confirmation by prospective study.