Journal of anesthesia
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Journal of anesthesia · Aug 2013
ReviewQT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes.
Electrophysiological abnormalities of the QT interval of the standard electrocardiogram are not uncommon. Congenital long QT syndrome is due to mutations of several possible genes (genotype) that result in prolongation of the corrected QT interval (phenotype). Abnormalities of the QT interval can be acquired and are often drug-induced. ⋯ If not recognized and corrected quickly, QT interval abnormalities may precipitate potentially fatal ventricular dysrhythmias. The main mechanism responsible for the development of QT prolongation is blockade of the rapid component of the delayed rectifier potassium current (I kr), encoded for by the human-ether-a-go-go-related gene (hERG). The objectives of this review were (1) to describe the electrical pathophysiology of QT interval abnormalities, (2) to differentiate congenital from acquired QT interval abnormalities, (3) to describe the currently known risk factors for QT interval abnormalities, (4) to identify current drug-induced causes of acquired QT interval abnormalities, and (5) to recommend immediate and effective management strategies to prevent unanticipated dysrhythmias and deaths from QT abnormalities in the perioperative period.
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Journal of anesthesia · Aug 2013
Case ReportsIntraoperative hypernatremia and polyuric syndrome induced by dexmedetomidine.
Hypernatremia and polyuria are the main symptoms of diabetes insipidus. Polyuria is characterized by a 24-h urine volume in excess of 40-50 ml/kg in adults. Dexmedetomidine, a highly selective, short-acting intravenous alpha-2 agonist, is used as a component of anesthesia, and has been suspected to induce polyuric syndrome. We report a patient who presented with severe hypernatremia and polyuria after intravenous infusion of dexmedetomidine.
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Journal of anesthesia · Aug 2013
Choice of loco-regional anesthetic technique affects operating room efficiency for carpal tunnel release.
Intravenous regional anesthesia (Bier block) is indicated for minor procedures such as carpal tunnel release but must be performed in the operating room. We hypothesize that preoperative peripheral nerve blocks decrease anesthesia-controlled time compared to Bier block for carpal tunnel release. With IRB approval, we reviewed surgical case data from a tertiary care university hospital outpatient surgery center for 1 year. ⋯ Anesthesia-controlled time [median (10th-90th percentiles)] was shorter for the nerve block group compared to Bier block [11 (6-18) vs. 13 (9-20) min, respectively; p = 0.02). Surgical time was also shorter for the nerve block group vs. the Bier block group [13 (8-21) and 17 (10-29) min, respectively; p < 0.01), but nerve blocks took 10 (5-28) min to perform. Ultrasound-guided nerve blocks performed preoperatively reduce anesthesia-controlled time compared to Bier block and may be a useful anesthetic modality in some practice environments.
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Journal of anesthesia · Aug 2013
Hippocampal volume reduction in elderly patients at risk for postoperative cognitive dysfunction.
Postoperative cognitive dysfunction (POCD) is a formidable public health issue, which would not only affect the quality of life among elderly patients but also lead to pulmonary infection and increased mortality. While, there is a lack of an effective indicator in predicting POCD. As one pivotal part of the limbic system in brain, hippocampus is associated with cognitive function. Hippocampal atrophy could indicate the degree of changes in cognitive function. ⋯ The MRI measurement of hippocampal volume is suggested to be valuable as a predictor of POCD in the elderly.
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Journal of anesthesia · Aug 2013
An in-hospital mortality equation for mechanically ventilated patients in intensive care units.
To develop an equation model of in-hospital mortality for mechanically ventilated patients in adult intensive care using administrative data for the purpose of retrospective performance comparison among intensive care units (ICUs). ⋯ Model 2 may potentially serve as an alternative model for predicting mortality in mechanically ventilated patients, who have so far required physiological data for the accurate prediction of outcomes. Model 2 may facilitate the comparative evaluation of in-hospital mortality in multicenter analyses based on administrative data for mechanically ventilated patients.