Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2012
Intravenous fluids cause systemic bias in a conductivity-based point-of-care hematocrit meter.
Point-of-care (POC) devices measuring hematocrit rely on determination of electrical conductivity of whole blood. We hypothesized that some frequently administered IV fluids independently alter blood conductivity and confound hematocrit determination. ⋯ Dilution of blood with frequently used IV solutions affects whole blood conductivity determinations and thereby decreases hematocrits measured by a POC device relying on this method as compared with spun hematocrit. Conductivity-based hematocrit POC devices should be cautiously interpreted when hemodilution is present.
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Anesthesia and analgesia · Feb 2012
Comparative StudyThe effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma.
Retrospective studies report that the benefit of regional anesthesia on cancer recurrence may depend on the specific tumor type. We compared the association between anesthetic technique and cancer recurrence in patients undergoing percutaneous radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC). ⋯ This retrospective analysis suggests that treatment of small HCC by RFA under general anesthesia is associated with reduced risk of cancer recurrence. No effect of anesthetic technique on overall survival is detected. Prospective, randomized trials to evaluate this association are warranted.
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Anesthesia and analgesia · Feb 2012
Case ReportsA neonate with long QT syndrome, refractory ventricular arrhythmias, and lidocaine toxicity.
Long QT syndrome is characterized by electrocardiographic appearance of long QT intervals and propensity to polymorphic ventricular tachycardia. Aggressive anticipatory clinical management is required for a good outcome, especially in the symptomatic neonate. ⋯ Despite normal serum lidocaine levels, complex pharmacokinetic interactions resulted in presumed neurotoxicity due to lidocaine. This report discusses the implications and challenges of management of a neonate with compound long mutations.
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Anesthesia and analgesia · Feb 2012
ReviewA review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia.
Phenylephrine is effective for the management of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery under spinal anesthesia. While ephedrine was previously considered the vasopressor of choice in obstetric patients, phenylephrine is increasingly being used. This is largely due to studies suggesting improved fetal acid-base status with the use of phenylephrine as well as the low incidence of hypotension and its related side effects with prophylactic phenylephrine regimens. ⋯ The impact of the administration of phenylephrine as a bolus for the treatment of established hypotension compared with its administration as a prophylactic infusion is discussed. This article also reviews the impact of phenylephrine compared with ephedrine on uteroplacental perfusion, and fetal outcomes such as neonatal acid-base status and Apgar scores. The optimum dosing regimen for phenylephrine administration is also discussed.
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Anesthesia and analgesia · Feb 2012
ReviewFibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding.
Fibrinogen plays several key roles in the maintenance of hemostasis. Its cleavage by thrombin and subsequent polymerization to form fibrin strands provides the structural network required for effective clot formation. During cases of acute blood loss, attempts to maintain circulating volume and tissue perfusion often involve the infusion of crystalloids, colloids, and red blood cells. ⋯ Although traditionally performed via administration of fresh frozen plasma or cryoprecipitate, the use of lyophilized fibrinogen (concentrate) is becoming more prevalent in some countries. Recent reports relating to the efficacy of fibrinogen concentrate suggest that it is a viable alternative to traditional hemostatic approaches, which should be considered. The prospective study of fibrinogen supplementation in acquired bleeding is needed to accurately assess the range of clinical settings in which this management strategy is appropriate, the most effective method of supplementation and a comprehensive safety profile of fibrinogen concentrate used for such an approach.