Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2013
ReviewReview article: the anesthetic considerations of intraoperative electrocorticography during epilepsy surgery.
Epilepsy surgery is a well-established therapeutic intervention for patients with medically refractory seizures. Success of epilepsy surgery depends on the accurate localization and complete removal of the epileptogenic zone. Despite the advances in presurgical localization modalities, electrocorticography is still used in approximately 60% to 70% of the epilepsy centers in North America to guide surgical resection of the epileptogenic lesion and to assess for completeness of surgery. In this review, we discuss the principles and intraoperative use of electrocorticography, the effect of anesthetic drugs on electrocorticography, and the use of pharmacoactivation for intraoperative localization of epileptogenic zone.
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Anesthesia and analgesia · Aug 2013
Outcomes of early delirium diagnosis after general anesthesia in the elderly.
Postoperative delirium in the elderly, measured days after surgery, is associated with significant negative clinical outcomes. In this study, we evaluated the prevalence and in-hospital outcomes of delirium diagnosed immediately after general anesthesia and surgery in elderly patients. ⋯ Delirium in the PACU is common, but not universal. It is associated with subsequent delirium on the ward, and potentially with a decline in cognitive function and increased institutionalization at hospital discharge.
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Anesthesia and analgesia · Aug 2013
Randomized Controlled TrialPreoperative carbohydrate loading in patients undergoing coronary artery bypass or spinal surgery.
Surgical stress creates a state of insulin resistance which may contribute to the development of hyperglycemia and, subsequently, postoperative complications. Consumption of an oral carbohydrate supplement before surgery may improve insulin sensitivity and reduce hyperglycemia. In this trial, we investigated the effects of carbohydrate supplementation on insulin resistance in coronary artery bypass graft and spinal decompression and fusion surgical patients. ⋯ Preoperative carbohydrate loading did not improve postoperative insulin sensitivity. However, the observed postoperative blood glucose levels and β-cell function as well as secondary outcomes warrant further study to reevaluate traditional fasting practices in surgical patients.
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Anesthesia and analgesia · Aug 2013
ReviewReview article: endotracheal tube cuff leaks: causes, consequences, and management.
The consequences of endotracheal tube (ETT) cuff leak may range from a bubbling noise to a life-threatening ventilatory failure. Although the definitive solution is ETT replacement, this is often neither needed nor safe to perform. Frequently, the leak is not caused by a structural defect in the ETT. ⋯ A risk/benefit analysis of each individual situation is warranted before decisions are made on how best to proceed. Alternative back-up ventilation plans should be preformulated and the necessary equipment ready before the exchange. In this review, various management concerns and plans are discussed, and a simple algorithm to manage leaky ETT cuff situations is presented.
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Anesthesia and analgesia · Aug 2013
Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study.
The use of normal saline is associated with hyperchloremic metabolic acidosis. In this study, we sought to determine the incidence of acute postoperative hyperchloremia (serum chloride >110 mEq/L) and whether this electrolyte disturbance is associated with an increase in length of hospital stay, morbidity, or 30-day postoperative mortality. ⋯ This retrospective cohort trial demonstrates an association between hyperchloremia and poor postoperative outcome. Additional studies are required to demonstrate a causal relationship between these variables.