Articles: postoperative.
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Acta Anaesthesiol Scand · Aug 2014
Observational StudyDynamic variables and fluid responsiveness in patients for aortic stenosis surgery.
Aortic stenosis is the most common valvular disease in developed countries, but it carries an increased mortality during non-cardiac surgery underscoring the importance of adequate hemodynamic management. Further, haemodynamic management of patients immediately after surgery for aortic stenosis can be challenging. Prediction of fluid responsiveness using dynamic variables has not been sufficiently studied in patients for aortic stenosis surgery. ⋯ The arterial pressure-based variables had moderate predictive values before valve replacement, but it predicted fluid responsiveness well postoperatively. Pleth variability index did not predict fluid responsiveness preoperatively, and it had a moderate predictive value postoperatively. These results indicate that arterial pressure-based dynamic variables have limited potential to guide fluid therapy in patients with aortic stenosis. Their ability to guide fluid therapy after aortic valve replacement seems better.
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Journal of anesthesia · Aug 2014
Case ReportsAltered responses to vasopressors of a patient medicated with carvedilol, pilsicainide and enalapril.
A patient scheduled for laparoscopic rectal surgery was medicated with carvedilol, an antagonist of beta 1-, beta 2- and alpha 1-adrenergic receptors, pilsicainide, a class Ic antiarrhythmic drug and enalapril, an angiotensin-converting enzyme inhibitor. Because the patient experienced attacks of atrial fibrillation with rapid ventricular response almost weekly, carvedilol and pilsicainide were continued up to the day of surgery, while enalapril was discontinued for 24 h prior to surgery. During the operation, he showed prolonged hypotension that did not respond to usual doses of vasopressors such as ephedrine, phenylephrine and dopamine but responded to higher doses of norepinephrine. Postoperatively, he was given dopamine but exhibited tachyarrhythmia until the dopamine infusion was discontinued.
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Many multimodal analgesia techniques have been tried to provide adequate analgesia for midline incisions extending above and below the umbilicus aiming at limiting the perioperative use of morphine thus limiting side effects. Ultrasound (US) guidance made the anesthesiologist reconsider old techniques for wider clinical use. The rectus sheath block (RSB) is a useful technique under-utilized in the adult population. ⋯ Ultrasound-guided rectus sheath block is an easy technique to learn. This technique, when it is used with general anesthesia, will be more effective in reducing pain scores and opioid consumption compared with general anesthesia alone.
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Multicenter Study Observational Study
Prospective External Validation of a Predictive Score for Postoperative Pulmonary Complications.
The 'Assess Respiratory Risk in Surgical Patients in Catalonia' risk score can predict post-operative pulmonary complications with adequate utility.
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