Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review Meta Analysis Comparative Study
Semi-invasive measurement of cardiac output based on pulse contour: a review and analysis.
The aim of this review was to provide a meta-analysis of all five of the most popular systems for arterial pulse contour analysis compared with pulmonary artery thermodilution, the established reference method for measuring cardiac output (CO). The five investigated systems are FloTrac/Vigileo(®), PiCCO(®), LiDCO/PulseCO(®), PRAM/MostCare(®), and Modelflow. ⋯ During hemodynamic instability, CO measurement based on continuous arterial pulse contour analysis shows only limited agreement with intermittent bolus thermodilution. The calibrated systems seem to deliver more accurate measurements than the auto-calibrated or the non-calibrated systems. For reliable use of these semi-invasive systems, especially for critical therapeutic decisions during hemodynamic disorders, both a strategy for hemodynamic optimization and further technological improvements are necessary.
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Observational Study
An observational cohort study to assess glycosylated hemoglobin screening for elective surgical patients.
Uncontrolled blood glucose is associated with a higher incidence of surgical site infections, greater utilization of resources, and increased mortality. Preoperative screening for diabetes in elective surgical patients is not routinely performed. The purpose of this study was to examine blood glucose control in a preoperative surgical population. ⋯ Many elective surgical patients are at risk for unrecognized postoperative hyperglycemia and associated adverse outcomes. Random blood sugar testing has limited value and HbA1c may be a more appropriate test for the preoperative assessment of diabetic patients.
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Intravenous leiomyomatosis is a rare disorder characterized by benign smooth-muscle tumours, termed leiomyomas, which originate from uterine leiomyomas or pelvic veins. Tumours may extend into the right-sided heart chambers, termed intracardiac leiomyomatosis (ICLM), and may be potentially life-threatening due to mechanical interference with cardiac structures or pulmonary arteries. While surgical excision is the optimal therapy, incomplete retrieval of a tumour or fatal retroperitoneal hemorrhage may occur. We present a case where intraoperative transesophageal ultrasound (TEU) guided complete removal of an intracardiac leiomyoma in a single-stage surgery solely through the right atrium without vein injury. ⋯ For cases with ICLM, intraoperative TEU plays a significant role in helping to plan the surgical approach, monitor the movement of the tumour and the IVC during the extraction, and assess the completeness of tumour resection.
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Whenever possible, neuraxial anesthesia is the preferred technique for Cesarean delivery; however, under certain circumstances, general anesthesia remains the most appropriate choice. The purpose of this Continuing Professional Development module is to review the key issues regarding general anesthesia for Cesarean delivery. ⋯ A general anesthetic for Cesarean delivery should be based on the following principles: preventing aspiration, anticipating a difficult intubation, maintaining oxygenation, insuring materno-feto-placental perfusion and maintaining a deep level of anesthesia to avoid intraoperative awareness while minimizing neonatal effects.