Articles: operative.
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Curr Opin Anaesthesiol · Aug 2005
Anaesthetics and the rate corrected interval: learning from droperidol?
Understanding of the long QT syndrome continues to evolve. Anaesthesia in patients with untreated long QT syndrome carries a risk of perioperative malignant ventricular arrhythmias. Genotypically susceptible individuals may have a normal rate-corrected QT interval and present with torsade de pointes intraoperatively. The likelihood of arrhythmias can be reduced by careful preoperative preparation. Perioperative disturbances in physiological homeostasis and drugs administered can prolong the rate-corrected QT interval. ⋯ Droperidol can lead to serious cardiac arrhythmias from QT prolongation. Recent advances in the pathophysiology of congenital and acquired long QT syndrome are reviewed. Preclinical tests assessing potential new drugs for QT prolongation are briefly discussed. Considerations for the management of these patients during perioperative phases are explored. The optimal treatment of the long QT syndrome is presented along with a glimpse into future possibilities in this field.
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Curr Opin Anaesthesiol · Aug 2005
Arginine vasopressin as a rescue vasopressor agent in the operating room.
This review gives an overview of the current knowledge and research on the use of arginine vasopressin in cardiac arrest and severe shock states. ⋯ Whereas arginine vasopressin in combination with epinephrine can significantly increase hospital discharge in cardiac arrest, arginine vasopressin combined with catecholamines improved haemodynamics in vasodilatory and haemorrhagic shock, but effects on outcome remain unknown. Nonetheless, in the perioperative setting, arginine vasopressin may already be considered as a potent adjunct vasopressor agent in advanced shock states unresponsive to conventional therapy.
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Although several potential risk factors have been discussed, risk factors associated with bacterial colonization or even infection of catheters used for regional anaesthesia are not very well investigated. ⋯ Colonization of peripheral and epidural nerve catheter can only in part be predicted at the time of catheter insertion since two out of three relevant variables that significantly influence the risk can only be recorded postoperatively. Catheter localisation in the groin, removal of the dressing and omission of postoperative antibiotics were associated with, but were not necessarily causal for bacterial colonization. These factors might help to identify patients who are at increased risk for catheter colonization.
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In many studies investigating measures to attenuate the hemodynamic and humoral stress response during induction of anaesthesia, primary attention was paid to the period of endotracheal intubation since it has been shown that even short-lasting sympathetic cardiovascular stimulation may have detrimental effects on patients with coronary artery disease. The aim of this analysis was, however, to identify the influencing factors on high catecholamine levels before induction of anaesthesia. ⋯ The oral administration of clonidine is the only significant predictor for the observed variation of norepinephrine levels during the preoperative period. Lack of significant dose responsiveness suggests that even a low dose of the drug can attenuate the preoperative stress response and thus is recommended in cardiovascular high risk patients.
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Postoperative administration of paracetamol or its prodrug propacetamol has been shown to decrease pain with a morphine sparing effect. However, the effect of propacetamol administered intra-operatively on post-operative pain and early postoperative morphine consumption has not been clearly evaluated. In order to evaluate the effectiveness of analgesic protocols in the management of post-operative pain, a standardized anesthesia protocol without long-acting opioids is crucial. Thus, for ethical reasons, the surgical procedure under general anesthesia with remifentanil as the only intraoperative analgesic must be associated with a moderate predictable postoperative pain. ⋯ Intraoperative propacetamol administration with remifentanil based-anesthesia improved significantly early postoperative pain by sparing morphine and shortening the delay to achieve pain relief.