AANA journal
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Review
Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events.
Alpha2-adrenergic agonists have been shown to reduce the incidence of perioperative myocardial morbidity and mortality. The purpose of this review article is to summarize the current data pertaining to alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. ⋯ The currently published randomized controlled trials indicate that alpha2-agonists reduce the incidence of myocardial ischemic episodes in patients with known or suspected coronary artery disease undergoing noncardiac surgery, and clonidine was shown to reduce mortality in noncardiac surgical patients. The authors of the studies concluded that while alpha2-agonists exert beneficial effects on hemodynamics and myocardial protection, large-scale, prospective, controlled trials are still needed.
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Randomized Controlled Trial
Effect of timing of fluid bolus on reduction of spinal-induced hypotension in patients undergoing elective cesarean delivery.
Spinal-induced hypotension remains the most common complication associated with spinal anesthesia for cesarean delivery. Recent evidence indicates that a 20-mL/kg bolus via pressurized infusion system administered at the time of subarachnoid block (SAB) (coload) may provide better prophylaxis than the traditional administration of a 20-mL/kg crystalloid infusion (preload) approximately 20 minutes before SAB; however, this method raises some concerns. We hypothesized that administering half of the fluid bolus (10 mL/kg) before and half immediately following injection of the SAB would provide benefit. ⋯ No differences in neonatal outcomes were noted between groups. Maternal vital signs were not significantly different between groups; hypotension was treated as it occurred. We recommend replacing standardized prophylactic crystalloid fluid administration with the preload/coload method described herein.
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Review Case Reports
Anesthetic considerations for the patient with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome).
Hereditary hemorrhagic telangiectasia (HHT), Osler-Weber-Rendu Syndrome, is an uncommon disease but may be present in many people who remain undiagnosed. It is an autosomal dominant disorder characterized by multiple arteriovenous malformations (AVMs) and telangiectases that affect multiple organ systems. Hereditary hemorrhagic telangiectasia patients have a propensity for bleeding, especially from the oropharynx, nasopharynx and gastrointestinal tract, as well as from rupture of AVMs of other organ systems. Anesthetic care of patients with HHT involves very specific interventions with regard to control of bleeding, maintaining adequate oxygenation, and balancing hemodynamic values to optimize perfusion without compromising anesthetic depth.
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Patients having surgical procedures are at risk for anoxia that may cause cognitive impairment. Continuous monitoring of cerebral oxygenation and perfusion with an instrument such as a cerebral oximeter is desirable. ⋯ This critical review of the literature on the efficacy, mechanics, and usefulness of the cerebral oximeter will be helpful to anesthesia providers in evaluating the controversy surrounding its use. A comprehensive understanding of the factors involved in cerebral perfusion and available equipment, such as the cerebral oximeter to monitor cerebral oxygenation, allows anesthetists to provide the best protection for the brain.
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Randomized Controlled Trial
Preoperative fluid bolus and reduction of postoperative nausea and vomiting in patients undergoing laparoscopic gynecologic surgery.
We conducted a randomized clinical trial of patients undergoing laparoscopic gynecologic surgery to determine the effect of a calculated preoperative fluid bolus on postoperative nausea and vomiting (PONV). For the study, 46 women were randomly assigned to an experimental group, group 1, or a control group, group 2. Group 1 received up to 1,000 mL of replacement fluid preoperatively, using the 4-2-1 formula. ⋯ Demographic and other factors reported to cause PONV, such as the length of surgery and major manipulation of the bowels, were similar in both groups. There was no significant difference between groups in reception of postoperative opioid, a known cause of PONV. Drops in blood pressure were thought to affect PONV, but group 1 patients had larger decreases in blood pressure than did group 2 patients.