Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2013
ReviewMeasuring Mitochondrial Oxygen Tension: From Basic Principles to Application in Humans.
The protoporphyrin IX-triplet state lifetime technique (PpIX-TSLT) has been recently introduced as the first method to measure mitochondrial oxygen tension (mitoPO2) in living cells and tissues. The current implementation of the technique is based on oxygen-dependent quenching of the delayed fluorescence lifetime of 5-aminolevulinic-acid-enhanced mitochondrial PpIX. It represents a significant step forward in our ability to comprehensively measure tissue oxygenation. ⋯ Clinical measurements of mitoPO2 are possible as demonstrated by cutaneous measurements in healthy volunteers. Applications of PpIX-TSLT in anesthesiology and intensive care medicine might, e.g., be monitoring mitoPO2 as a resuscitation end point, targeting oxygen homeostasis in the critically ill, and assessing mitochondrial function at the bedside. PpIX-TSLT likely also has applications in other fields also, e.g., providing an oxygen-related feedback signal in photodynamic therapy of malignant tumors.
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Anesthesia and analgesia · Oct 2013
Randomized Controlled TrialThe Influence of Spinal Flexion in the Lateral Decubitus Position on the Unilaterality of Spinal Anesthesia.
For unilateral spinal block, local anesthetics should affect the spinal nerves of 1 side. With full flexion of the spine, the sunken cauda equina becomes tightened and is suspended in the middle of the subarachnoid space. We performed this study to assess whether spinal flexion facilitates unilateral spinal anesthesia. ⋯ Strict unilateral sensory block was not achieved even after lateral decubitus positioning with spinal flexion, when 8 mg hyperbaric bupivacaine was administered manually at a conventionally slow rate through a beveled spinal needle. However, maintaining flexion of the spinal column during lateral decubitus positioning altered the initial onset of sensory block with respect to laterality.
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Anesthesia and analgesia · Oct 2013
The Association Between Perioperative Hemoglobin and Acute Kidney Injury in Patients Having Noncardiac Surgery.
Acute kidney injury (AKI) is a common complication of noncardiac surgery and is associated with excess morbidity and mortality. Perioperative hemoglobin concentrations are strongly associated with surgical mortality, but little is known about their relationship with AKI. We studied hemoglobin concentration before and 24 hours after surgery and its association with AKI. ⋯ Low preoperative and early postoperative decrements in hemoglobin concentrations are strongly associated with postoperative AKI in a graded manner. Given the frequency of low perioperative hemoglobin and decreases in hemoglobin concentration, research is needed to determine whether there are safe treatment strategies to mitigate the risk of AKI.
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Anesthesia and analgesia · Oct 2013
EditorialThe Effective Concentration of Tranexamic Acid for Inhibition of Fibrinolysis in Neonatal Plasma In Vitro.
Neonates are at high risk for bleeding complications after cardiovascular surgery. Activation of intravascular fibrinolysis is one of the principal effects of cardiopulmonary bypass that causes poor postoperative hemostasis. Antifibrinolytic medications such as tranexamic acid are often used as prophylaxis against fibrinolysis, but concentration/effect data to guide dosing are sparse for adults and have not been published for neonates. Higher concentrations of tranexamic acid than those necessary for inhibition of fibrinolysis may have adverse effects. Therefore, we investigated the concentration of tranexamic acid necessary to inhibit activated fibrinolysis in neonatal plasma. ⋯ Our data establish the minimal effective concentration of tranexamic acid necessary to completely prevent fibrinolysis in neonatal plasma in vitro. These data may be useful in designing a dosing scheme for tranexamic acid appropriate for neonates.
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Much more than a telephone, today's mobile device has become an integral part of the way we interface with the world. Mobile devices have the computing capability, display, and battery power to become powerful medical devices that measure vital signs and provide intelligent interpretation or immediate transmission of information. ⋯ This readily available computing power will also extend the utility of vital signs monitoring to new clinical indications, especially with the use of additional processing and integration of information. This review will focus on the universal promotion of pulse oximetry and advanced processing of plethysmography to assess variables such as respiratory rate, capillary refill time, and fluid responsiveness, and how these measurements may assist with perioperative monitoring, diagnosis, and management of pneumonia in children and preeclampsia in pregnancy when combined with mobile devices.