Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2013
ReviewSelection of Obese Patients Undergoing Ambulatory Surgery: A Systematic Review of the Literature.
The incidence of obesity has increased over the past 2 decades. In recent years, several studies have assessed perioperative outcomes in obese patients undergoing ambulatory surgery. However, this evidence has not been reviewed and evaluated systematically. ⋯ The literature lacks adequate information to make strong recommendations regarding appropriate selection of the obese patients scheduled for ambulatory surgery. The literature does indicate that the super obese (BMI >50 kg/ m) do present an increased risk for perioperative complications, while patient with lower BMIs do not seem to present any increased risk as long as any comorbidities are minimal or optimized before surgery. This review also identifies knowledge gaps and recommends future research required to guide optimal selection of obese patients scheduled for ambulatory surgery.
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Anesthesia and analgesia · Nov 2013
Observational StudyFIBTEM PLUS Provides an Improved Thromboelastometry Test for Measurement of Fibrin-Based Clot Quality in Cardiac Surgery Patients.
The viscoelastic functional fibrinogen (FF) and FIBTEM assays measure the contribution of fibrin to clot strength. Inhibition of platelet function is a necessary precondition for these tests to work. We investigated a novel test for measuring fibrin-based clotting, FIBTEM PLUS, in cardiac surgery and compared it with FF and FIBTEM. ⋯ The FIBTEM PLUS assay produces precise results. At baseline, it provides greater inhibition of platelets than FIBTEM, but there is no meaningful difference between FIBTEM PLUS and FIBTEM in patients with low platelet counts.
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Anesthesia and analgesia · Nov 2013
The Effect of Endoplasmic Reticulum Stress on Neurotoxicity Caused by Inhaled Anesthetics.
The mechanisms by which inhaled anesthetics cause neurotoxicity are not well clarified. Exposure to inhaled anesthetics induces a release of Ca from the endoplasmic reticulum (ER) into the cytosol. Aberrant Ca mobilization may alter the protein-folding environment in the ER, causing ER stress. Binding immunoglobulin protein (BiP) is an ER chaperone that is critical to ER functions. Because ER stress leads to cellular dysfunction and apoptotic cell death, leading to diverse human disorders such as neurodegenerative diseases, we hypothesized ER stress may play a role in neurotoxicity caused by inhaled anesthetics. ⋯ Sevoflurane exposure may cause ER stress, which is tolerated to some extent in wild-type cells. When this tolerance is limited, like in cells with mutant BiP, the exposure leads to cell death in the brain, suggesting that ER stress may partially mediate neurotoxicity caused by inhaled anesthetics. This study suggests that patients with certain conditions sensitive to ER stress such as ischemia, hypoxia, developing brain, or neurodegenerative diseases may be vulnerable to inhaled anesthetics.
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Anesthesia and analgesia · Nov 2013
Automated, Real-Time Fresh Gas Flow Recommendations Alter Isoflurane Consumption During the Maintenance Phase of Anesthesia in a Simulator-Based Study.
The Low Flow Wizard (LFW) provides real-time guidance for user optimization of fresh gas flow (FGF) settings during general inhaled anesthesia. The LFW can continuously inform users whether it determines their FGF to be too little, efficient, or too much, and its color-coded recommendations respond in real time to changes in FGF performed by users. Our study objective was to determine whether the LFW feature, as implemented in the Dräger Apollo workstation, alters FGF selection and thereby volatile anesthetic consumption without affecting patient care. ⋯ Our data in a simulated anesthetic suggest that enabling the display of FGF efficiency data by the LFW results in a median percent reduction in volatile liquid anesthetic consumption rate of 53.2%. Since the lower limit of the 95% confidence interval for the median is 39.4%, this finding is likely to translate into cost savings and less waste anesthetic gas generated in the clinical setting and released into the atmosphere.
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Anesthesia and analgesia · Nov 2013
The Distinct Effects of Lipid Emulsions Used for "Lipid Resuscitation" on Gating and Bupivacaine-Induced Inhibition of the Cardiac Sodium Channel Nav1.5.
Systemic administration of lipid emulsions is an established treatment for local anesthetic intoxication. However, it is unclear by which mechanisms lipids achieve this function. The high cardiac toxicity of the lipophilic local anesthetic bupivacaine probably results from a long-lasting inhibition of the cardiac Na channel Nav1.5. In this study, we sought to determine whether lipid emulsions functionally interact with Nav1.5 or counteract inhibition by bupivacaine. ⋯ Our data indicate that lipid emulsions reduce rather than increase availability of Nav1.5. However, both Intralipid and Lipofundin partly relieve Nav1.5 from block by bupivacaine. These effects are likely to involve not only a direct interaction of lipids with Nav1.5 but also the ability of lipid emulsions to absorb bupivacaine and thus reduce its effective concentration.