Articles: function.
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Postoperative residual neuromuscular block has been recognized as a potential problem for decades, and it remains so today. Traditional pharmacologic antagonists (anticholinesterases) are ineffective in reversing profound and deep levels of neuromuscular block; at the opposite end of the recovery curve close to full recovery, anticholinesterases may induce paradoxical muscle weakness. The new selective relaxant-binding agent sugammadex can reverse any depth of block from aminosteroid (but not benzylisoquinolinium) relaxants; however, the effective dose to be administered should be chosen based on objective monitoring of the depth of neuromuscular block. ⋯ Although in many settings, subjective (visual and tactile) evaluation of muscle responses is used, such evaluation has had limited success in preventing the occurrence of residual paralysis. Clinical evaluations of return of muscle strength (head lift and grip strength) or respiratory parameters (tidal volume and vital capacity) are equally insensitive at detecting neuromuscular weakness. Objective measurement (a train-of-four ratio greater than 0.90) is the only method to determine appropriate timing of tracheal extubation and ensure normal muscle function and patient safety.
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Critical care medicine · Jan 2017
Multicenter Study Observational StudyChronic Kidney Disease After Acute Kidney Injury Requiring Continuous Renal Replacement Therapy and Its Impact on Long-Term Outcomes: A Multicenter Retrospective Cohort Study in Korea.
Severe acute kidney injury requiring continuous renal replacement therapy is associated with a high risk of early mortality. Our objectives were to identify a cohort of early survivors and to follow their renal progress and long-term mortality. ⋯ Renal functional assessment at 3 months after continuous renal replacement therapy initiation can be useful in predicting progression to end-stage renal disease and long-term mortality. Furthermore, continuous close monitoring and management of acute kidney injury patients requiring continuous renal replacement therapy are required, even in those with recovered renal function.
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Observational Study
Racial differences in health-related quality of life and functional ability in patients with gout.
To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout. ⋯ African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes.
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Minerva anestesiologica · Jan 2017
ReviewThe link between anesthesiology and neurology: a mindful cooperation to improve brain protection.
Preventing neurological injury is mandatory during the perioperative period of any kind of surgery and in the care of critically ill patients in the intensive care unit. During daily practice, both anesthesiologists and neurologists focus on brain protection as an integral part of systemic homeostasis maintenance. This article highlights the intriguing overlap between anesthesiology and neurology in clinical practice along with its potential implications for outcome. ⋯ Clinical vigilance and the use of shared monitoring and diagnostic technology could allow early recognition and treatment of cerebral dysfunction occurring in the perioperative period or in the critical care setting, thus reducing morbidity and mortality. In order to improve patient safety and outcome, neurologists and anesthesiologists should more closely and successfully collaborate, using shared monitoring tools and integrating traditional areas of expertise. Daily activity, education, research and training programs in anesthesia and neurology could benefit from a stronger relationship with each other.
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Establishment of cutpoints for classifying mild, moderate and severe pain is commonly based on single rating of worst or average pain. However, single pain measure may serve as a brief and partial surrogate for composite pain ratings. This study aimed to base composite pain ratings to establish optimal cutpoint that maximized the difference of pain interference on daily function and compare its utility with those based on single worst and average pain. ⋯ The results suggest that using optimal cutpoint for composite pain may be useful to classify clinically important groups in patients with chronic pain and that average pain may be an alternative choice if a single item is used. WHAT DOES THIS STUDY ADD?: Using composite pain, optimal classification for mild, moderate and severe pain exhibited better discriminant ability than using single worst/average pain. The difficulty hierarchy of the least, worst, average and current pain helps to screen people with irregular responses.