Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2014
A Combination of Mild Hypothermia and Sevoflurane Affords Long-Term Protection in a Modified Neonatal Mouse Model of Cerebral Hypoxia-Ischemia.
Infant brain injury from hypoxia-ischemia (HI) can lead to life-long impairment, but protective strategies are lacking. Short-term but not long-term protection has been demonstrated in the Rice-Vannucci neonatal brain ischemia model (RVM) by volatile anesthetic administration before HI, while exposure during HI has not been tested. In the current study, we evaluated a combination of sevoflurane and mild hypothermia as a protective approach during HI, both short- and long-term, by introducing intubation and mechanical ventilation to the RVM. ⋯ To test the neuroprotective effects of volatile anesthetics during neonatal brain ischemia, we developed a modification of the RVM. By using mechanical ventilation and endotracheal intubation, sevoflurane administration during HI was survivable. The combination of sevoflurane administration and mild hypothermia during HI conferred not only short-term structural, but also long-term functional protection, compared with littermates treated according to the RVM. These findings warrant further studies to improve neurological outcome in critically ill infants.
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Anesthesia and analgesia · Nov 2014
ReviewTrauma Bleeding Management: The Concept of Goal-Directed Primary Care.
The early and aggressive high-volume administration of fresh frozen plasma, platelet concentrates, and red blood cells (RBCs), using ratio-driven massive transfusion protocols, has been adopted by many for the treatment of trauma-induced coagulopathy and hemorrhagic shock. However, the optimal ratio of RBC: fresh frozen plasma and RBC:platelet concentrate is still under investigation. ⋯ Both a ratio-driven coagulation therapy and a point-of-care-guided coagulation management based on coagulation factor concentrates aim for the same target-the rapid prevention and treatment of shock and coagulopathy to prevent death from traumatic hemorrhage. In this review, we compare the evidence relating to the effectiveness and safety of the ratio-driven and goal-directed approaches to trauma-induced coagulopathy to draw attention to the potential benefits and drawbacks associated with these management strategies.
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Anesthesia and analgesia · Nov 2014
Randomized Controlled TrialDoes Anesthetic Regimen Influence Implicit Memory During General Anesthesia?
Implicit learning of intraoperative auditory stimuli during general anesthesia is very difficult to quantify but may require the presence of noxious stimulation. We hypothesized that an anesthetic regimen with a low dose of opioid would enhance implicit memory, while a regimen with a high dose of opioid would not. ⋯ We could not demonstrate the presence of implicit or explicit memorization under propofol-remifentanil anesthesia either with a low- or a high-dose opioid anesthetic regimen.
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Anesthesia and analgesia · Nov 2014
Editorial CommentChasing the shadows of implicit memory under anesthesia.