Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Perioperative hypothermia (33 degrees C) does not increase the occurrence of cardiovascular events in patients undergoing cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial.
Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage. ⋯ In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.
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Comparative Study
Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study.
Epidural or spinal anesthesia involves several mechanisms hypothesized to reduce risk of surgical site infections (SSIs) during this decisive period. This study aims to compare the risk of SSI within 30 days of surgery for patients receiving total hip or knee replacement under general anesthesia versus those under epidural or spinal anesthesia. ⋯ Total hip or knee replacement under general anesthesia is associated with higher risk of SSI compared with epidural or spinal anesthesia. Our results support the evolving concept of long-term consequences of anesthesia and emphasize the anesthesiologist's role in preventing SSIs.
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Comparative Study
Preoperative prolonged steroid use is not associated with intraoperative blood transfusion in noncardiac surgical patients.
Prolonged steroid therapy is reportedly associated with changes in coagulation, suggesting increased intraoperative bleeding or hypercoagulability. The aim of this retrospective study was to assess whether long-term steroid use was associated with increased transfusion requirements, infection, or hypercoagulability in adults undergoing noncardiac surgery. ⋯ The effect of prolonged steroid use on bleeding, if any, thus seems likely to be small and is probably of limited clinical consequence. In contrast, corticosteroid use augments the risk of both systemic and wound infections.
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Recent clinical trials investigating the role of hyperoxia in decreasing surgical site infection have reported conflicting results. Immunologic mechanisms through which supplemental oxygen could act have not been elucidated fully. The authors sought to investigate the effects of hyperoxia on previously tested and prognostically significant innate immune parameters to uncover the potential effects of hyperoxia at the cellular level. ⋯ Hyperoxia exerts significant effects on multiple cellular and immunologic parameters, providing a potential mechanism for benefits from the use of supplemental oxygen. However, the ability to translate positive basic scientific findings to the operating suite or bedside require the existence of similar innate immune processes in vivo and the efficient transfer of oxygen to the sites where it may be used.