Anesthesiology
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The development of arterial spin labeling methods has allowed measuring regional cerebral blood flow (rCBF) quantitatively and to show the pattern of cerebral activity associated with any state such as a sustained pain state or changes due to a neurotropic drug. ⋯ The observation that quantitative rCBF changes are characteristic of the pain task used and that there is a consistent rCBF change in Brodman area 6, an area responsible for the integration of a motor response to pain, should provide extremely useful information in the quest to develop an imaging biomarker of pain. Conceivably, response in BA6 may serve as an objective measure of analgesic efficacy.
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Right heart failure is an important cause of perioperative morbidity and mortality, and transesophageal echocardiography (TEE) is crucial for its diagnosis. However, only four of the 20 cross-sectional views recommended in current guidelines for intraoperative TEE focus on the right heart. This study analyzed whether incorporating additional views into the standard TEE examination improves assessment of the right heart. ⋯ The additional TEE views focusing on the right heart can be acquired as reliably as standard views. Incorporating three of them into the standard TEE examination improves comprehensive assessment of the right heart.
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Ischemia-reperfusion (I-R) injury is a sterile inflammatory process that is commonly associated with diverse clinical situations such as hemorrhage followed by resuscitation, transient embolic events, and organ transplantation. I-R injury can induce lung dysfunction whether the I-R occurs in the lung or in a remote organ. Recently, evidence has emerged that receptors and pathways of the innate immune system are involved in recognizing sterile inflammation and overlap considerably with those involved in the recognition of and response to pathogens. ⋯ The data reveal that alveolar macrophages and the pattern recognition receptor toll-like receptor-4 are involved in the generation of the early inflammatory response to lung I-R injury.
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Ultrasound can influence the diagnosis and impact the treatment plan in critical patients. The aim of this study was to determine whether, without encountering major environment- or patient-related limitations, ultrasound examination under a critical care ultrasonography protocol can be performed to detect occult anomalies, to prompt urgent changes in therapy or induce further testing or interventions, and to confirm or modify diagnosis. ⋯ In this series of patients consecutively admitted to an intensive care unit, ultrasound examination revealed a high prevalence of unsuspected clinical abnormalities, with the highest number of new ultrasound abnormalities detected in patients with septic shock. As part of rapid global assessment of the patient on admission, our ultrasound protocol holds potential for improving healthcare quality.
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The authors sought to determine whether subjects with pathophysiological conditions that are characterized by increased concentrations of aldosterone have increased susceptibility to the side effects of neonatal anesthesia with sevoflurane. ⋯ These results suggest that adverse developmental effects of neonatal anesthesia with sevoflurane may involve both central and peripheral actions of the anesthetic. Subjects with increased concentrations of aldosterone may be more vulnerable, whereas intracerebral oxytocin receptor agonists may be neuroprotective.