Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 2010
Pulse pressure and long-term survival after coronary artery bypass graft surgery.
Data from longitudinal studies reveal that widened pulse pressure (PP) is a major predictor of coronary heart disease and mortality, but it is unknown whether PP similarly decreases survival after coronary artery bypass graft (CABG) surgery for coronary heart disease. We therefore assessed long-term survival in patients with increased PP at the time of presentation for CABG surgery. ⋯ An increase in perioperative PP is associated with poor long-term survival after CABG surgery. Together with our previous report linking PP to in-hospital fatal and nonfatal vascular complications, the established models for surgical risk assessment, patient counseling, and treatment should be revised to include PP.
-
The number of elderly patients with frank or incipient Alzheimer's disease (AD) requiring surgery is growing as the population ages. General anesthesia may exacerbate symptoms of and the pathology underlying AD, so minimizing anesthetic exposure may be important. This requires knowledge of whether the continuing AD pathogenesis alters anesthetic potency. ⋯ These results show that the genetic vulnerabilities and neuropathology associated with AD produce a small but significant decrease in sensitivity to the hypnotic actions of three inhaled anesthetics. Emergence times were not altered.
-
Anesthesia and analgesia · Feb 2010
Comparative StudyA retrospective effectiveness study of loss of resistance to air or saline for identification of the epidural space.
Randomized trials comparing air to saline for loss of resistance (LOR) for identification of the epidural space have suggested the superiority of saline. We hypothesized that, in actual clinical practice, anesthesiologists using their preferred technique would produce similar analgesic outcomes with either air or saline. ⋯ When used at the anesthesiologist's discretion, there is no significant difference in block success between air and saline for localization of the epidural space by LOR.
-
Anesthesia and analgesia · Feb 2010
Case ReportsCapacity to give surgical consent does not imply capacity to give anesthesia consent: implications for anesthesiologists.
There is precedent in medicine for recognizing and accepting intact decisional capacity and the subsequent ability to provide valid consent in one treatment domain, while simultaneously recognizing that the patient lacks decisional capacity in other domains. As such, obtaining consent for anesthesia for a surgical procedure is a separate entity from obtaining consent for the surgery itself. ⋯ Anesthesiologists should understand the independence of these functionally linked consent processes and be vigilant with respect to the informed consent process. The cases reported in this article show that capacity for surgical consent may be inadequate for consent to anesthesia because anesthesia involves more abstract concepts requiring a higher cognitive state than surgery, thus requiring a higher state of cognitive capacity for understanding.
-
Anesthesia and analgesia · Feb 2010
The effect of hydroxyethyl starches (HES 130/0.42 and HES 200/0.5) on activated renal tubular epithelial cells.
Acute renal failure is a frequent complication of sepsis. Hydroxyethyl starch (HES) is widely used in the treatment of such patients. However, the effect of HES on renal function during sepsis remains controversial. We established an in vitro model of tumor necrosis factor-alpha (TNF-alpha)-stimulated human proximal tubular epithelial (HK-2) cells to assess the possible effects of HES 130/0.42 and HES 200/0.5 on these activated cells. ⋯ This in vitro study shows that both HES products modulate cell injury upon inflammatory stimulation. The effect was more pronounced in the HES 200/0.5 group than for HES 130/0.42, suggesting a possible biological difference between the HES types.