Anesthesia and analgesia
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Anesthesia and analgesia · May 2011
Randomized Controlled TrialHigh-dose remifentanil suppresses sinoatrial conduction and sinus node automaticity in pediatric patients under propofol-based anesthesia.
We sought to determine the effect of remifentanil on sinus node function and the atrial-His (AH) interval in pediatric patients undergoing radiofrequency catheter ablation. ⋯ Remifentanil may inhibit both intraatrial conduction and sinus node automaticity, but it has no effect on conduction through the atrioventricular node. Dose dependency was not observed within the range of 0.2 to 0.4 μg · kg(-1) · min(-1) of remifentanil.
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Chronological age is a well-established risk factor for the development of cardiovascular diseases. The changes that accumulate in the vasculature with age, however, are highly variable. ⋯ In this review, we highlight some of the pathophysiological mechanisms that characterize the vascular aging phenotype. Furthermore, we provide an overview of the key outcome studies that address the value of these vascular health indices in general and discuss potential effects on perioperative cardiovascular outcomes.
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Anesthesia and analgesia · May 2011
Randomized Controlled Trial Comparative StudyDreaming in sedation during spinal anesthesia: a comparison of propofol and midazolam infusion.
Although sedation is often performed during spinal anesthesia, the details of intraoperative dreaming have not been reported. We designed this prospective study to compare 2 different IV sedation protocols (propofol and midazolam infusion) with respect to dreaming during sedation. ⋯ In cases of spinal anesthesia with deep sedation, dreaming was almost 5 times more common in patients receiving propofol infusion than in those receiving midazolam, although this did not influence satisfaction with the sedation. Thus, one does not need to consider intraoperative dreaming when choosing propofol or midazolam as a sedative drug in patients undergoing spinal anesthesia.
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Anesthesia and analgesia · May 2011
ReviewReview article: improving outcome after major surgery: pathophysiological considerations.
Surgical and anesthesia-related techniques may reduce physical stress for patients undergoing high-risk surgery, but major surgery is increasingly performed in patients with substantial comorbidities. Strategies for improving the outcome for such patients include approaches that both increase tissue oxygen delivery and reduce metabolic demand. However, these strategies have produced conflicting results. ⋯ Our aim in this review is to provide a survey of fields of opportunities for improving outcome after major surgery. The issues are approached from 3 different angles: the view of the patient, the view of the surgical intervention, and the view of the anesthesia. Special attention is also given to what could be considered the result of the interaction among the 3: perioperative inflammation and immune response.
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Anesthesia and analgesia · May 2011
Medical intelligence article: novel uses of high frequency ventilation outside the operating room.
High frequency jet ventilation (HFJV) is a technique that is most frequently used in the intensive care unit and during tracheal and otorhinolaryngologic surgery. The utility of HFJV for procedures performed outside of the intensive care unit and operating room is currently being explored. The ability of HFJV to provide mechanical ventilation, yet achieve near static conditions of the chest and abdomen, makes it a very appealing technique for procedures such as pulmonary vein isolation and ablation for atrial fibrillation, targeted radiation therapy for lung and liver tumors, and certain diagnostic imaging techniques.