Journal of clinical anesthesia
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The adrenal gland is a vital endocrine organ, and adrenal steroid synthesis and secretion are closely regulated by the hypothalamic-pituitary-adrenal (HPA) axis in response to various stimuli. Surgery or trauma can activate the HPA axis and induce the secretion of cortisol. Different cortisol responses vary with the grade of surgery. ⋯ Stress response inhibition can reduce postoperative complications, such as pain and cognitive dysfunction. This is protective to patients during perioperative and postoperative periods. The aim of the present review is to shed light on current evidence regarding the exact effects and mechanisms of perioperative medications on the HPA response to surgical injury and provide the applicable guidance on clinical anesthesia.
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Observational Study
Diagnostic accuracy of a simple qualitative ultrasound assessment for the diagnosis of high-risk gastric contents in the parturient. A prospective observational cohort study.
Interpretation of gastric ultrasound relies on the use of a clinical algorithm that combines qualitative analysis of the gastric antrum contents with the calculation of the volume of fluid contents. This reference method may be difficult to apply in the parturient. We therefore aimed to assess the diagnostic accuracy of a simple qualitative assessment in the supine position for the diagnosis of high-risk gastric contents in the parturient. We also assessed the diagnostic accuracy of a composite scale and another clinical algorithm based on a mathematical model different to that used in the reference method. ⋯ These results suggest that simple qualitative assessment may be useful in clinical practice to help the anesthesiologist in the assessment of gastric contents status and risk of aspiration.
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Anesthesia departments can reduce their environmental impact. Barriers exist to the promotion of individual anesthesiologists' roles in environmentally sustainable practices. We hypothesized that accountability of departmental leadership is associated with reports of practices that can encourage and sustain environmentally favorable practices. ⋯ Anesthesia department chairs and departments with annual performance evaluations that included items related to environmental sustainability reported more activities to promote sustainability. The result suggests that leadership-sponsored initiatives directed toward environmental sustainability are associated with environmental sustainability activities in anesthesia departments.