Medical science monitor : international medical journal of experimental and clinical research
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Randomized Controlled Trial
Combined vs. Isoflurane/Fentanyl anesthesia for major abdominal surgery: Effects on hormones and hemodynamics.
Combination of epidural and general anesthesia (combined anesthesia) avoids the intraoperative use of intravenous analgesics and may reduce the surgical stress response during major abdominal surgery. This study examines the differences in intraoperative hemodynamic stability, cortisol levels and activity of cardiovascular hormones between combined anesthesia and isoflurane/fentanyl anesthesia. ⋯ Combined anesthesia reduces the intraoperative stress response, but moderate hemodynamic instability is relatively common and has to be compensated for by adequate volume replacement and vasopressor support.
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Case Reports
Differentiating subscapular tendon and glenohumeral joint on anterior shoulder sonography.
Anterior sonography of the glenohumeral joint has been suggested as a useful method of assessing inflammatory joint disease. The proximity of the subscapular tendon (SSC) to the glenohumeral joint (GHJ) in the shoulder might require differentiating between these two structures. ⋯ Differentiating SSC and GHJ on anterior shoulder sonography with above mentioned sonographic features misinterpretation of US data might be minimized.
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In spontaneously breathing patients, the differences between arterial PaCO2 and end-tidal CO2 (EtCO2) and the influence of bronchial obstruction have not clearly established. ⋯ Capnographic results at Vt are accurate predictors of true PaCO2 only in patients without bronchial obstruction. The maneuvers of slow maximal expiration overestimate PaCO2 in all groups. The best concordance was obtained comparing PaCO2 with mean EtCO2.
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The ideal endpoint of resuscitation after severe hemorrhage should indicate not only that optimal oxygen delivery has been achieved, but also that oxygen utilization has been restored. A modified Foley catheter for simultaneous assessment of microcirculatory blood flow (TBF) and mitochondrial NADH in the urethral wall was used in the female swine. We hypothesized that changes in mitochondrial NADH and TBF are associated with impaired energy metabolism in the urethra and that these changes correlate with impaired tissue perfusion in the bladder during shock and resuscitation. ⋯ Changes in TBF and NADH in the urethral mucosa represent novel markers for the energetic state of the tissue. They could be measured in vivo by a minimally invasive approach and thus could provide important information on the end-points of resuscitation in hemorrhagic shock.
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Obstructive sleep apnea (OSA) has been linked to cardiovascular and cerebrovascular diseases in previous studies. However, it remains unclear whether OSA relates to cardiovascular outcomes independently of obesity and/or insulin resistance. ⋯ These findings suggest that severe OSA is related to higher cardiovascular risk independently of obesity and insulin resistance.