Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2018
Randomized Controlled TrialLactate, lactate clearance and outcome after cardiac arrest: A post-hoc analysis of the TTM-Trial.
Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting. ⋯ Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.
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Acta Anaesthesiol Scand · Nov 2018
CYP3A4 gene polymorphism is correlated with individual consumption of sufentanil.
Pain is one of the major adverse clinical outcomes of cesarean section (CS). In the past few years, researchers and physicians have been optimizing post-operative analgesic modalities, but the results are still undesirable for the parturient. The cytochrome P-450 3A4 (CYP3A4) gene has been reported to contribute significantly to human liver microsomal oxidation of sufentanil and alfentanil. ⋯ In summary, we found a correlation between CYP3A4 genetic polymorphism and sufentanil consumption. This might be helpful for optimizing the anesthesia strategies and reducing their side effects.
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Acta Anaesthesiol Scand · Nov 2018
Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018.
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. ⋯ For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).