Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2016
Baseline Pulse Pressure, Acute Kidney Injury, and Mortality After Noncardiac Surgery.
Increased pulse pressure (PP) is an important independent predictor of cardiovascular outcome and acute kidney injury (AKI) after cardiac surgery. The objective of this study was to determine whether elevated baseline PP is associated with postoperative AKI and 30-day mortality after noncardiac surgery. ⋯ We found a significant association between elevated baseline PP and postoperative AKI in patients who underwent noncardiac surgery. However, elevated PP was not significantly associated with more advanced stages of postoperative AKI or 30-day mortality in these patients.
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Anesthesia and analgesia · Dec 2016
Comparative Study Observational StudyLong-Acting Patient-Controlled Opioids Are Not Associated With More Postoperative Hypoxemia Than Short-Acting Patient-Controlled Opioids After Noncardiac Surgery: A Cohort Analysis.
Opioids can contribute to postoperative desaturation. Short-acting opioids, titrated to need, may cause less desaturation than longer-acting opioids. We thus tested the primary hypothesis that long-acting patient-controlled intravenous opioids are associated with more hypoxemia (defined as an integrated area under a postoperative oxyhemoglobin saturation of 95%) than short-acting opioids. ⋯ Long-acting patient-controlled opioids were not associated with the increased hypoxemia during the first 2 postoperative days.
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Anesthesia and analgesia · Dec 2016
Comparative StudyA Comparison of a New Ultrasound-Based Whole Blood Viscoelastic Test (SEER Sonorheometry) Versus Thromboelastography in Cardiac Surgery.
Viscoelastic thromboelastography tests such as TEG™ are now routine for assessing the coagulation status of cardiac surgery patients. We compared TEG™ with a new technology, sonic estimation of elasticity via resonance (SEER) sonorheometry, to compare measures of coagulation dynamics of whole blood and assess its potential for rapid, near-point-of-care monitoring of hemostasis during cardiac surgery. ⋯ Currently, no viscoelastic hemostatic analyzer system can be considered the "gold standard"; therefore, differences observed between TEG™ and SEER are of importance only because they show that the methods are not perfectly substitutable. Measurements of clot stiffness determined by the 2 methods were correlated but not interchangeable. Reasons for discrepancies include the substantial difference in the physical methods of inducing coagulation activation in samples and the mathematical assumptions underlying calculations of G. Future studies will be required to evaluate SEER sonorheometry's abilities to identify bleeding diatheses (sensitivity/specificity) or to develop treatment algorithms based on the new tests.
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Anesthesia and analgesia · Dec 2016
Comparative StudyDiagnostic Accuracy of Neuromonitoring for Identification of New Neurologic Deficits in Pediatric Spinal Fusion Surgery.
Intraoperative neuromonitoring (IONM) modalities, transcranial motor-evoked potentials (TcMEPs), and somatosensory-evoked potentials (SSEPs) are accepted methods to identify impending spinal cord injury during spinal fusion surgery. Debate exists over sensitivity and specificity of these modalities. Our purpose was to measure the incidence of new neurologic deficits (NNDs) and estimate sensitivity and specificity of IONM modalities. ⋯ TcMEPs are more sensitive than SSEP at detecting an impending NND. IONM modalities are highly specific. Both sensitivity and specificity are impacted substantially by assumptions of the impact of interventions on alerts and NND. Properly designed, controlled, multicenter studies are required to establish diagnostic accuracy of IONM in scoliosis surgery.
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Anesthesia and analgesia · Dec 2016
ADRB2 gly16gly Genotype, Cardiac Output, and Cerebral Oxygenation in Patients Undergoing Anesthesia for Abdominal Aortic Aneurysm Surgery.
Gly16arg polymorphism of the adrenergic β2-receptor is associated with the elevated cardiac output (Q) in healthy gly16-homozygotic subjects. We questioned whether this polymorphism also affects Q and regional cerebral oxygen saturation (SCO2) during anesthesia in vascular surgical patients. ⋯ This study suggests that the β2-adrenoceptor gly16gly genotype is associated with the elevated resting Q. An interesting trend to greater frontal lobe oxygenation at induction of anesthesia in patients with gly16gly genotype was found, but because of insufficient sample size and lack of PCO2 control throughout the measurements, the presented data may only serve as the hypothesis generating for future studies. The confidence limits indicate that the magnitude of the effects may range from clinically insignificant to potentially important.