Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2008
ReviewAnemia and cerebral outcomes: many questions, fewer answers.
A number of clinical studies have associated acute anemia with cerebral injury in perioperative patients. Evidence of such injury has been observed near the currently accepted transfusion threshold (hemoglobin [Hb] concentration, 7-8 g/dL), and well above the threshold for cerebral tissue hypoxia (Hb 3-4 g/dL). However, hypoxic and nonhypoxic mechanisms of anemia-induced cerebral injury have not been clearly elucidated. ⋯ Potential mechanisms of cerebral protection include NOS/NO-dependent optimization of cerebral oxygen delivery and cytoprotective mechanisms including HIF-1alpha, erythropoietin, and vascular endothelial growth factor. The overall balance of these activated cellular mechanisms may dictate whether or not their up-regulation leads to cytoprotection or cellular injury during anemia. A clearer understanding of these mechanisms may help us target therapies that will minimize anemia-induced cerebral injury in perioperative patients.
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Anesthesia and analgesia · Oct 2008
ReviewP6 stimulation for the prevention of nausea and vomiting associated with cesarean delivery under neuraxial anesthesia: a systematic review of randomized controlled trials.
A number of studies investigated the use of P6 stimulation for the prevention of intraoperative and postoperative nausea and vomiting (IONV and PONV) in women having cesarean delivery under neuraxial anesthesia. We performed a systematic review to determine the overall efficacy of these techniques in preventing IONV and PONV in this patient population. ⋯ While some studies showed a benefit of P6 stimulation, this finding was not consistent. The presence of heterogeneity and inconsistent results among the included trials prevents any definitive conclusions on the efficacy of P6 stimulation in reducing IONV and PONV associated with cesarean delivery performed under neuraxial anesthesia.
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Anesthesia and analgesia · Oct 2008
ReviewInfusate contamination in regional anesthesia: what every anesthesiologist should know.
Infection can be a devastating complication of regional anesthesia. Contaminated infusate as a cause of infection in neuraxial anesthesia or peripheral nerve blockade has rarely been reported in the literature. However, it may be an important source of morbidity, especially as increasing numbers of patients are being discharged with perineural catheters and portable pumps of local anesthetic, which may infuse for several days at home. ⋯ In the United States, there are currently no national guidelines on the hang-times of regional anesthesia infusates. On the other hand, guidelines for the sterile compounding of infusions used in regional anesthesia are now established by United States Pharmacopeia and The National Formulary Chapter 797, entitled "Pharmaceutical Compounding, Sterile Preparations." These guidelines have significant implications for the anesthesiologist. In this review, we examined the available literature regarding contaminated infusate as a cause of infection in regional anesthesia, to discuss strategies for the prevention of such contamination including the appropriate hang-time for infusates, and to discuss the implications of United States Pharmacopeia and The National Formulary Chapter 797 for anesthesiologists.