Journal of anesthesia
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Obesity seems to be the modern concern to society. An increasing number of obese patients present annually to surgical wards to undergo surgical procedures. ⋯ These include the preoperative evaluation of the consequences of obesity, particularly on cardiac, respiratory, and metabolic systems; airway management; different pharmacokinetic and pharmacodynamic drug regimen; and perioperative management (i.e., hemodynamic, respiratory, and hyperglycemic). This paper reviews and assesses the most important anesthetic issues in managing obese patients.
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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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The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. ⋯ In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients.
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Journal of anesthesia · Feb 2012
ReviewAdditive diuretic response of concurrent aminophylline and furosemide in children: a case series and a brief literature review.
Aminophylline exerts a renovascular effect, acting by adenosine receptor blockade or type IV phosphodiesterase inhibition. Clinically, these drugs have been used with furosemide to induce diuresis in adults and neonates. ⋯ No side effects were evident. Administration of aminophylline at low doses (3 mg/kg) successfully promoted increased urine output over the 6-h study period in all four children.