Journal of anesthesia
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Journal of anesthesia · Dec 2011
Review Meta AnalysisAccuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysis.
Stroke volume variation (SVV) appears to be a good predictor of fluid responsiveness in critically ill patients. However, a wide range of its predictive values has been reported in recent years. We therefore undertook a systematic review and meta-analysis of clinical trials that investigated the diagnostic value of SVV in predicting fluid responsiveness. ⋯ SVV is of diagnostic value in predicting fluid responsiveness in various settings.
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Journal of anesthesia · Dec 2011
ReviewManagement of postoperative nausea and vomiting in women scheduled for breast cancer surgery.
Breast cancer surgery performed under general anesthesia is associated with a high incidence of postoperative nausea and vomiting (PONV). A number of approaches are available for the management of PONV after breast cancer surgery. First, the risk factors related to patient characteristics, surgical procedure, anesthetic technique, and postoperative care can be reduced. ⋯ Unfortunately, the use of glucocorticoids and SR antagonists for preventing PONV is not permitted in Japan according to national health insurance guidelines. Fourth, electro-acupoint stimulation at the P6 point (Nei-Guwan) as a non-pharmacologic therapy is as effective as ondansetron for preventing PONV. Knowledge of the risk factors for PONV, antiemetics, and a non-pharmacologic approach are needed for the management of PONV in women undergoing breast cancer surgery.
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Journal of anesthesia · Oct 2011
Review Historical ArticleThe role of Certified Registered Nurse Anesthetists in the United States.
Certified Registered Nurse Anesthetists (CRNAs) have been providing anesthesia care in the United States (US) for nearly 150 years. Historically, anesthesia care for surgical patients was mainly provided by trained nurses under the supervision of surgeons until the establishment of anesthesiology as a medical specialty in the US. Currently, all 50 US states utilize CRNAs to perform various kinds of anesthesia care, either under the medical supervision of anesthesiologists in most states, or independently without medical supervision in 16 states; the latter has become an on-going source of conflict between anesthesiologists and CRNAs. Understanding the history and current conditions of anesthesia practice in the US is crucial for countries in which the shortage of anesthesia care providers has become a national issue.
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Journal of anesthesia · Aug 2011
ReviewPossible link between cyclooxygenase-inhibiting and antitumor properties of propofol.
The intravenous anesthetic propofol has a number of well-known nonanesthetic effects, including anti-oxidation and anti-emesis. Another interesting nonanesthetic effect of propofol may be its cyclooxygenase (COX)-inhibiting activity. This activity may have important clinical implications, as propofol could have antitumor properties through COX inhibition. ⋯ Therefore, propofol could be a particularly suitable anesthetic for use during the perioperative period for cancer surgery. However, whether the COX-inhibiting activity of propofol is related to the reported antitumor properties of propofol is not known. Definitive evidence remains to be provided.
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Journal of anesthesia · Apr 2011
ReviewAnesthetic management of noncardiac surgery for patients with single ventricle physiology.
Patients with congenital heart diseases are a growing population, and noncardiac surgeries will become an important health care issue. Patients with single ventricle physiology are a particularly challenging population who will undergo staged, palliative repair toward a final step of Fontan circulation. Although Fontan surgery creates a serial circulation in which the ventricle pumps blood to the systemic circuit, pulmonary blood flow occurs without a dedicated ventricle. ⋯ Health care professionals must prepare for these patients to present to noncardiac surgery at any stage of intervention, possibly with complications. Given that staged, palliative repair has undergone multiple modifications, patients who present for surgery can vary in types and timing of the repair. Anesthesiologists who care for them must be familiar with perioperative issues to optimize outcomes, especially because congenital heart disease is a risk factor for increased mortality for noncardiac surgery.