Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2014
ReviewExtracorporeal membrane oxygenation in the adult: a review of anticoagulation monitoring and transfusion.
Extracorporeal membrane oxygenation (ECMO) is a method of life support to maintain cardiopulmonary function. Its use as a medical application has increased since its inception to treat multiple conditions including acute respiratory distress syndrome, myocardial ischemia, cardiomyopathy, and septic shock. While complications including neurological and renal injury occur in patients on ECMO, bleeding and coagulopathy are most common. ⋯ In this review article, we discuss the evolution of the various modalities of ECMO, indications, contraindications, and complications. Furthermore, we review the different strategies for anticoagulation and treatment of coagulopathy while on ECMO. Finally, we discuss the cost of ECMO and associated blood product transfusion.
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Anesthesia and analgesia · Apr 2014
Randomized Controlled Trial Multicenter StudyPostoperative Delirium in a Substudy of Cardiothoracic Surgical Patients in the BAG-RECALL Clinical Trial.
Low average volatile concentration shows some association with post-operative delirium in a sub-study analysis of cardiothoracic patients admitted post-operatively to ICU, although clinical implications are unclear. Use of BIS was not statistically significantly associated with a lower incidence of delirium, although there was a trend to lower incidence.
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Anesthesia and analgesia · Apr 2014
Comparative StudyIntraoperative three-dimensional versus two-dimensional echocardiography for left ventricular assessment.
Three-dimensional (3D) transesophageal echocardiography (TEE) technology is now widely used intraoperatively in cardiac surgery. Left ventricular (LV) measurements with 3D transthoracic echocardiography correlate better with cardiac magnetic resonance measurements compared with traditional two-dimensional (2D) transthoracic echocardiography. In this study, we compared intraoperative 3D TEE against 2D TEE regarding quantitative indices of LV function. ⋯ Intraoperative 3D TEE quantification of LV global function, image acquisition time, and reproducibility was not statistically different when compared with 2D TEE. It was however associated with calculation of larger LV volumes and a longer analysis time. Nevertheless, the 3-zone error grid analysis of the LV indexed volumes showed that the difference between 3D and 2D measurements does not affect the LV classification as normal, mildly to moderately dilated, or severely dilated.
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Anesthesia and analgesia · Apr 2014
Comparative StudyChanges in plasma orexin-a levels in sevoflurane-remifentanil anesthesia in young and elderly patients undergoing elective lumbar surgery.
Delayed emergence from general anesthesia frequently occurs in elderly patients, but the reason is not clear. Orexin has been shown to be involved in arousal from general anesthesia. In this study, we examined plasma orexin-A levels in both elderly and young patients during the anesthesia arousal cycle. ⋯ Plasma orexin-A levels are not responsible for the delayed emergence from general anesthesia in elderly patients.