Journal of anesthesia
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Journal of anesthesia · Aug 2012
Randomized Controlled TrialThe effect of dexmedetomidine on arterial-cardiac baroreflex function assessed by spectral and transfer function analysis.
The α(2)-adrenergic receptor agonist dexmedetomidine reportedly weakens heart rate (HR) responses to 'rapid' (during a few seconds) reduction in arterial pressure, but does not affect HR responses to 'gradual' (during 60 s) reduction in arterial pressure. As the speed of neurotransmission along the parasympathetic nerve is relatively rapid, alteration of parasympathetic-mediated arterial-cardiac baroreflex function plays a more important role in HR responses to 'rapid' changes in arterial pressure. We therefore hypothesized that dexmedetomidine attenuates parasympathetic-mediated arterial-cardiac baroreflex function. ⋯ The present results suggest that dexmedetomidine attenuates parasympathetic-mediated arterial-cardiac baroreflex function, implying weakened HR response to 'rapid' reduction in arterial pressure.
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Journal of anesthesia · Aug 2012
Review Meta AnalysisA comprehensive appraisal of meta-analyses focusing on nonsurgical treatments aimed at decreasing perioperative mortality or major cardiac complications.
Millions of patients worldwide who undergo surgical procedures face significant morbidity and mortality risks. Several systematic reviews have been performed on ancillary treatments aimed at improving surgical outcomes, but their features and scholarly impact are unclear. We describe characteristics of meta-analyses on ancillary treatments aimed at improving surgical outcomes and explore factors associated with scholarly citations. ⋯ Systematic reviews currently represent a key element in defining state of the art ancillary treatments of patients undergoing surgery. However, the citation success of available meta-analyses is not significantly associated with prognostically relevant findings or quality features.
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It has been over 40 years since the term "neuroanesthesia" emerged. The anesthesiologists specializing in neuroanesthesia have actively conducted basic research on cerebral ischemia as well as on cerebral blood flow and metabolism. However, translating the results of basic research using experimental animals into clinical applications has been often unsuccessful, especially in the area of cerebral ischemia. ⋯ Nevertheless, the accuracy of basic research can be improved by taking measures to reduce bias. Taking such measures may enable more careful judgments to be made at the basic research stage and prevent unnecessary clinical studies. Although it could be seen as taking a slight detour, it is advisable to create a system that facilitates confirmation of the original findings by a multicenter basic research project before starting a collaborative multicenter clinical trial.
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Journal of anesthesia · Aug 2012
Case ReportsIncidence and neurological outcomes of aneurysm rupture during interventional neuroradiology procedures in a hybrid operating suite.
A hybrid operating suite, where craniotomy, brain CT scanning, fluoroscopy, and angiography can be performed on the same operating table, is becoming popular among neurosurgeons. However, whether use of a hybrid operating suite can improve neurological outcome has not been studied. ⋯ Despite emergency neurosurgical intervention within 2 h of rupture of the aneurysms, two of these five patients died and one patient had permanent neurological deficit postsurgery. Whether use of a hybrid operating suite improves neurological outcome remains uncertain.
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Journal of anesthesia · Aug 2012
Risk factors for gastric distension in patients with acute appendicitis: a retrospective cohort study.
There has been no report on risk factors for gastric distension (GD) when inducing general anesthesia in an emergency situation. The aim of this study was to clarify the risk factors for GD in patients with acute appendicitis at their hospital visit. ⋯ Younger appendicitis patients with acute abdominal pain for 1 or more days should be treated as patients with high risk for GD.