Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 2015
Randomized Controlled Trial Comparative StudyExcess Costs and Length of Hospital Stay Attributable to Perioperative Respiratory Events in Children.
This prospective matched-cohort study from Thailand found that children experiencing a perioperative respiratory event were subsequently hospitalized twice as long, incurred 30% higher hospital costs, along with 58% higher indirect costs.
summary -
Anesthesia and analgesia · Feb 2015
Review Meta Analysis Comparative StudyCrystalloids Versus Colloids: Exploring Differences in Fluid Requirements by Systematic Review and Meta-Regression.
Positive fluid balance has been associated with worse outcomes, and knowledge of differences in the amounts of different types of fluid needed to achieve the same end points may have important clinical implications. Large molecules persist longer in the blood vessels than smaller molecules, such that less IV colloid may be needed to achieve similar hemodynamic end points compared with crystalloid. Recent clinical data have, however, challenged this physiological concept, with investigators reporting lower-than-expected crystalloid/colloid ratios in various populations. ⋯ Greater fluid volumes are required to meet the same targets with crystalloids than with colloids, with an estimated ratio of 1.5 (1.36-1.65), but there is marked heterogeneity among studies. The crystalloid/colloid ratio seems to have decreased over the years, and differences in ratios are correlated with the concentration of albumin solutions; however, the main reasons behind the high heterogeneity among studies remain unclear.
-
Anesthesia and analgesia · Feb 2015
ReviewAn update of the role of Renin Angiotensin in cardiovascular homeostasis.
The renin angiotensin system (RAS) is thought to be the body's main vasoconstrictor system, with physiological effects mediated via the interaction of angiotensin II with angiotensin I receptors (the "classic" RAS model). However, since the discovery of the heptapeptide angiotensin 1-7 and the development of the concept of the "alternate" RAS system, with its ability to reduce arterial blood pressure, our understanding of this physiologic system has changed dramatically. In this review, we focus on the newly discovered functions of the RAS, particularly the potential clinical significance of these developments, especially in the realm of new pharmacologic interventions for treating cardiovascular disease.
-
Anesthesia and analgesia · Feb 2015
Randomized Controlled TrialA pilot study on the effect of nasal continuous positive airway pressure on arterial partial pressure of carbon dioxide during spinal anesthesia with intravenous sedation for total knee arthroplasty.
Deep sedation of surgical patients may be associated with hypoventilation, airway collapse, and hypercarbia, although the extent of hypercarbia is rarely quantified. In this prospective, randomized, controlled clinical pilot study, we assessed the efficacy of nasal continuous positive airway pressure (nCPAP) for reducing arterial partial pressure of carbon dioxide (PaCO2) among deeply sedated, spontaneously ventilated patients undergoing total knee arthroplasty (TKA) under subarachnoid block (SAB), versus standard airway management in a control group. ⋯ Deep sedation of TKA patients during SAB resulted in moderate hypercarbia (mean and median PaCO2 = 55). There was a trend showing that nCPAP treatment reduced PaCO2 versus treatment for control group patients receiving standard airway management; however, estimated treatment difference varied widely, from 1.4 to 12.6 mm Hg. Among control group patients, the initial PaCO2 during deep sedation was similar to the PaCO2 when measured after a 30-minute period of continued deep sedation. Finally, baseline PaCO2 among deeply sedated patients who received an airway was not different from that of patients who did not receive an airway.
-
Anesthesia and analgesia · Feb 2015
Gas analysis using Raman spectroscopy demonstrates the presence of intraperitoneal air (nitrogen and oxygen) in a cohort of children undergoing pediatric laparoscopic surgery.
Clinically significant gas embolism during laparoscopy is a rare but potentially catastrophic event. Case reports suggest that air, in addition to the insufflation gas, may be present. We studied the effects of equipment design and flushing techniques on the composition of gas present under experimental and routine pediatric surgical conditions. ⋯ Thus, when vascular injury occurs, embolized gases will contain variable quantities of N2, O2, and CO2. As the initial insufflation volume diminishes and approaches the volume of the insufflation tubing, which occurs in infants and young pediatric patients, the concentration of N2 will approximate that of room air in an unflushed system. Small insufflation volumes containing high N2 concentrations can contribute to catastrophic air emboli in neonates and small pediatric patients.