Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 2013
ReviewDecision Support for Hemodynamic Management: From Graphical Displays to Closed Loop Systems.
The way hemodynamic therapies are delivered today in anesthesia and critical care is suboptimal. Hemodynamic variables are not always understood correctly and used properly. The adoption of hemodynamic goal-directed strategies, known to be clinically useful, is poor. ⋯ However, most therapeutic decisions cannot be based on a limited number of output variables. Therefore, one should focus on the development of systems designed to relieve clinicians from very simple and repetitive tasks. Whether intraoperative goal-directed fluid therapy may be one of these tasks remains to be evaluated.
-
Anesthesia and analgesia · Oct 2013
The Association Between Preoperative Anemia and 30-Day Mortality and Morbidity in Noncardiac Surgical Patients.
Anemia has been associated with increased postoperative morbidity and mortality. We used the American College of Surgeons National Surgical Quality Improvement Program database to retrospectively assess the relationship between preoperative anemia and 30-day postoperative mortality and morbidity in noncardiac surgical patients, careful to distinguish confounding variables from mediator variables. ⋯ Preoperative anemia appears to be associated with baseline diseases that markedly increase mortality. Anemia per se is a rather weak independent predictor of postoperative mortality. Our analysis also illustrates how analyzing large variable-rich registries challenges investigators to discriminate between confounding variables and mediator variables, i.e., factors that might be considered as "causal pathways" for the effect of the exposure or intervention on outcome.
-
Anesthesia and analgesia · Oct 2013
Propofol Shares the Binding Site with Isoflurane and Sevoflurane on Leukocyte Function-Associated Antigen-1.
We previously demonstrated that propofol interacted with the leukocyte adhesion molecule leukocyte function-associated antigen-1 (LFA-1) and inhibited the production of interleukin-2 via LFA-1 in a dependent manner. However, the binding site(s) of propofol on LFA-1 remains unknown. ⋯ We demonstrated that propofol bound to the lovastatin site in LFA-1. Previously we showed that the volatile anesthetics isoflurane and sevoflurane bound to this site. Taken together, the lovastatin site is an example of the common binding sites for anesthetics currently used clinically.
-
Anesthesia and analgesia · Oct 2013
Maternal Sepsis Mortality and Morbidity During Hospitalization for Delivery: Temporal Trends and Independent Associations for Severe Sepsis.
Sepsis is currently the leading cause of direct maternal death in the United Kingdom. In this study, we aimed to determine frequency, temporal trends, and independent associations for severe sepsis during hospitalization for delivery in the United States. ⋯ Maternal severe sepsis and sepsis-related deaths are increasing in the United States. Severe sepsis often occurs in the absence of a recognized risk factor and underscores the need for developing systems of care that increase sensitivity for disease detection across the entire population. Physicians should enhance surveillance in patients with congestive heart failure, chronic liver disease, chronic renal disease, and systemic lupus erythematous and institute early treatment when signs of sepsis are emerging.
-
Anesthesia and analgesia · Oct 2013
Direct Pulse Oximetry Within the Esophagus, on the Surface of Abdominal Viscera, and on Free Flaps.
Pulse oximetry is a noninvasive photometric technique that provides information about arterial blood oxygen saturation (SpO2) and heart rate and has widespread clinical applications. This is accomplished via peripheral pulse oximetry probes mainly attached to the finger, toe, or earlobe. The direct application of pulse oximetry to an organ, such as the esophagus, liver, bowel, stomach or free flap, might provide an indication of how well perfused an organ or a free flap is. Also, the placement of a pulse oximetry probe at a more central site, such as the esophagus, might be more reliable at a time when conventional peripheral pulse oximetry fails. ⋯ The technological developments and the measurements presented in this work pave the way to a new era of pulse oximetry where direct and continuous monitoring of blood oxygen saturation of internal organs and tissues (esophagus, bowel, liver, stomach, free flaps) could be possible.