Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2013
A transesophageal echocardiography technique to locate the kidney and monitor renal perfusion.
Monitoring the renal arterial Doppler flow velocity indices, the resistive index and pulsatility index, with ultrasound may help predict renal dysfunction. However, such monitoring has been done intermittently by transcutaneous ultrasound in the postoperative intensive care setting. In the operating room, transesophageal echocardiography (TEE) is an alternative to transcutaneous ultrasound for obtaining indices of renal perfusion. ⋯ We propose a new technique to locate the left kidney that, in our experience, is simple and easy to perform. We believe, starting from a transgastric left ventricular short-axis view, turning left to locate the abdominal aorta, and following it to the origin of the left renal artery may help locate the left kidney faster than previously described techniques. We also propose a new technique to monitor these Doppler indices using TEE during the intraoperative period.
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Anesthesia and analgesia · Mar 2013
Single-dose application of antithrombin as a potential alternative anticoagulant during continuous renal replacement therapy in critically ill patients with advanced liver cirrhosis: a retrospective data analysis.
Adequate anticoagulation is essential to achieve efficient and cost-effective continuous renal replacement therapy (CRRT). However, in critically ill patients with advanced liver cirrhosis, this goal is challenging because of the concomitant bleeding disorder. Therefore, the evaluation of alternative anticoagulants is necessary. ⋯ Our data suggest that anticoagulation with single doses of AT may be an alternative to continuously administered low-dose heparin in critically ill patients with advanced liver cirrhosis during CRRT. However, additional controlled trials are necessary to confirm our findings.
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Anesthesia and analgesia · Mar 2013
Microarray analyses of genes regulated by isoflurane anesthesia in vivo: a novel approach to identifying potential preconditioning mechanisms.
Although general anesthetics are recognized for their potential to render patients unconscious during surgery, exposure can also lead to long-term outcomes of both cellular damage and protection. As regards the latter, delayed anesthetic preconditioning is an evolutionarily conserved physiological response that has the potential for protecting against ischemic injury in a number of tissues. Although it is known that delayed preconditioning requires de novo protein synthesis, knowledge of anesthetic-regulated genes is incomplete. In this study, we used the conserved nature of preconditioning to analyze differentially regulated genes in 3 different rat tissues. We hypothesized that by selecting those genes regulated in multiple tissues, we could develop a focused list of gene candidates potentially involved in delayed anesthetic preconditioning. ⋯ Through using an analysis approach focusing on coordinately regulated genes, we were able to generate a focused list of interesting gene candidates with potential to enable future preconditioning studies.