Journal of anesthesia
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Journal of anesthesia · Apr 2014
Observational StudyIncidence of postoperative delirium is high even in a population without known risk factors.
Postoperative delirium is a recognized complication in populations at risk. The aim of this study is to assess the prevalence of early postoperative delirium in a population without known risk factors admitted to the ICU for postoperative monitoring after elective major surgery. The secondary outcome investigated is to identify eventual independent risk factors among demographic data and anesthetic drugs used. ⋯ In this study early postoperative delirium was found to be a very common complication after major surgery, even in a population without known risk factors. Thiopentone was independently associated with an increase in its relative risk.
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Journal of anesthesia · Apr 2014
Observational StudyLow molecular weight pentastarch is more effective than crystalloid solution in goal-directed fluid management in patients undergoing major gastrointestinal surgery.
This prospective observational study compared the volume effect between hydroxyethyl starch (HES) and crystalloid solution and its context dependency in intraoperative goal-directed fluid management. ⋯ HES 70/0.5 exerted larger volume effects than did crystalloid under nonspecific conditions. However, similar volume effects were observed during volume loss and extensive sympathetic blockade.
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Journal of anesthesia · Apr 2014
Antinociceptive effect of intracerebroventricular administration of D-serine on formalin-induced pain.
In a previous study using the tail-flick test, we found that intracerebroventricular administration of D-serine, an endogenous co-agonist at the glycine sites of N-methyl-D-aspartate (NMDA) receptors, elicited an antinociceptive effect on thermal nociception. The purpose of the present study was to evaluate the effect of intracerebroventricular administration of D-serine on nociception induced by tissue damage or inflammation using the formalin test. ⋯ The present data suggest that activation of NMDA receptors via glycine sites at the supraspinal level induces an antinociceptive effect on both acute and tonic pain.
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Journal of anesthesia · Apr 2014
Breathing movements of the chest and upper abdomen in mechanically ventilated paralyzed patients.
Assessment of breathing on clinical examination requires visualization of "chest" wall movement. However, in mechanically ventilated paralyzed patients, chest expansion is smaller than that of the abdomen. The aim of this study was to determine chest and upper abdominal movements in mechanically ventilated patients under general anesthesia. ⋯ Upper abdominal wall excursions were significantly larger than those of the chest wall in mechanically ventilated paralyzed patients, regardless of BMI. Assessment of breathing by clinical examination should avoid emphasis on "chest" wall movement alone, and instead include upper abdominal wall movement.