Articles: function.
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Anesthesia and analgesia · Feb 2014
Stationary versus agitated storage of whole blood during acute normovolemic hemodilution.
Acute normovolemic hemodilution is an intraoperative technique to reduce the number of red blood cells lost in shed blood during surgery. Standard guidelines for storage of platelets recommend constant gentle agitation to maintain gas exchange for the metabolically active platelets. The collected whole blood (WB) for acute normovolemic hemodilution remains stationary for as long as 8 hours before reinfusion. We hypothesized that gentle agitation of WB throughout storage would improve the coagulation properties of the WB at the time of reinfusion. ⋯ Given the small sample size, there is no statistical evidence on which to reject the null hypothesis of there being no difference in the changes from the baseline between coagulation function as measured by TEG® between WB that is either agitated or kept stationary for 8 hours. These findings need to be confirmed in a larger study.
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Because of a lack of contemporary data regarding seizures after cardiac surgery, we undertook a retrospective analysis of prospectively collected data from 11 529 patients in whom cardiopulmonary bypass was used from January 2004 to December 2010. A convulsive seizure was defined as a transient episode of disturbed brain function characterised by abnormal involuntary motor movements. Multivariate regression analysis was performed to identify independent predictors of postoperative seizures. ⋯ Mean (IQR [range]) length of stay in the intensive care unit was 115 (49-228 [32-481]) h in patients with convulsive seizures compared with 26 (22-69 [14-1080]) h in patients without seizures (p < 0.001). Convulsive seizures are a serious postoperative complication after cardiac surgery. As tranexamic acid is the only modifiable factor, its administration, particularly in doses exceeding 80 mg.kg(-1), should be weighed against the risk of postoperative seizures.
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Anesthesia and analgesia · Feb 2014
The Importance of Subjective Facial Appearance on the Ability of Anesthesiologists to Predict Difficult Intubation.
Previously we demonstrated that a computer algorithm based on bedside airway examinations and facial photographs accurately classified easy and difficult airways. The extent of the ability of anesthesiologists to perform the same task is unknown. We hypothesized that providing photographs would add to the predictive ability of anesthesiologists over that achieved when provided only with the Mallampati (MP) score and the thyromental distance (TMD). We further hypothesized that human observers would implicitly bias their predictions toward more sensitive determination of difficult airways, rather than more specific determination of easy airways. ⋯ Anesthesiologists can derive useful information from facial appearance that enhances the prediction of a difficult airway over that achieved when presented with MP and TMD data alone. Anesthesiologists implicitly bias their predictions toward detection of difficult airways, compared with the true incidence of difficult airways, at the expense of accuracy and specificity. This behavior may be rational for cognitive tasks in which the costs of failure are strongly asymmetric.
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Intact pharyngeal function and coordination of breathing and swallowing are essential for airway protection and to avoid respiratory complications. Postoperative pulmonary complications caused by residual effects of neuromuscular-blocking agents occur more frequently in the elderly. Moreover, elderly have altered pharyngeal function which is associated with increased risk of aspiration. The purpose of this study was to evaluate effects of partial neuromuscular block on pharyngeal function, coordination of breathing and swallowing, and airway protection in individuals older than 65 yr. ⋯ Partial neuromuscular block in healthy elderly individuals causes an increased incidence of pharyngeal dysfunction from 37 to 71%, with impaired ability to protect the airway; however, the authors were unable to detect an effect of partial neuromuscular block on coordination of breathing and swallowing.
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Curr Opin Anaesthesiol · Feb 2014
ReviewCritical care strategies to improve neurocognitive outcome in thoracic surgery.
This review focuses on neurocognitive outcome with respect to potential pathophysiological inflammatory mechanisms of thoracic surgery and one-lung ventilation, risk factors of postoperative delirium and postoperative cognitive dysfunction (POCD) as well as anti-inflammatory strategies. ⋯ There is evidence that important key strategies improve neurocognitive outcome after thoracic surgery. This includes adequate risk stratification, the anesthetic management and postoperative critical care strategies.