Journal of anesthesia
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Journal of anesthesia · Dec 2021
ReviewAdrenal function/dysfunction in critically ill patients: a concise narrative review of recent novel insights.
The "fight or flight" response to critical illness relies on increased cortisol availability, traditionally attributed to several-fold-increased cortisol production via hypothalamus-pituitary-adrenal-axis activation. Recent studies provided evidence against this concept with clinical implications. First, high cortisol availability during critical illness is driven by suppressed cortisol binding and reduced cortisol breakdown rather than increased cortisol production. ⋯ In long-stay ICU patients, central adrenal insufficiency may occur due to lack of trophic ACTH signaling. Finally, the Cosyntropin test is not suitable to assess adrenocortical reserve in ICU patients as the test is confounded by increased cortisol distribution volume. These insights necessitate further research focusing on the need, if any, of treating ICU patients with corticosteroids, and timing thereof, outside indications for pharmacological anti-inflammatory drugs.
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Journal of anesthesia · Dec 2021
Observational StudyPeripheral oxygen saturation to inspiratory oxygen fraction ratio-based identification of critically ill coronavirus disease patients for early therapeutic interventions.
Early identification of critically ill coronavirus disease (COVID-19) patients in clinical settings is crucial in reducing the mortality rate. Therefore, this study aimed to determine whether the saturation of peripheral oxygen (SpO2) to fraction of inspiratory oxygen (FiO2) ratio (SF ratio) at admission is useful for the early identification of severe COVID-19. ⋯ SF ratio measurement at admission could assist clinicians in the early identification of severe COVID-19, which in turn can lead to early therapeutic interventions.
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Journal of anesthesia · Dec 2021
Clinically relevant concentration of propofol and benzodiazepines did not affect in vitro angiogenesis.
Angiogenesis, one of regenerative medicine, is essential in the process of wound healing. The detailed effects of intravenous anesthetics and sedatives used during perioperative period have not yet been clarified. We investigated the effects of benzodiazepines and propofol on in vitro capillary tube formation. ⋯ Propofol and benzodiazepines except high-dose midazolam did not affect in vitro angiogenesis. High-dose midazolam may impair in vitro capillary tube formation due to by suppressing proliferation and migration of endothelial cells via activation of ERK.
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Journal of anesthesia · Dec 2021
Peripheral nerve block use in ankle arthroplasty and ankle arthrodesis: utilization patterns and impact on outcomes.
Ankle arthrodesis and total ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve blocks (PNB), large-scale data are lacking. Using national data, we aimed to evaluate PNB utilization pattern and its impact on outcomes. ⋯ III.