Journal of Anesthesia & Critical Care: Open Access最新文献

{"title":"Oral anticoagulation with rivaroxaban as thromboprophylaxis in patients recovered from COVID-19 pneumonia in Veracruz, Mexico","authors":"L. C. Orantes, J. S. S. Díaz, K. G. P. Moguel, Elisa Estefanía Aparicio- Sánchez, O. Rodríguez, Omar García- Hernández, Alejandro Escobar- Huerta, Azael Ahumada- Zamudio, Andrés Realino Velasco- Caicero, Olga González- Segovia, Ernesto Javier PachecoPérez, Álvaro Efrén Munguia- Sereno, Edna Rosario Contreras Sánchez, S. Hernández, Luis Jaime Medrano-Rios, Ada Lili Rosas-Lozano","doi":"10.15406/JACCOA.2021.13.00463","DOIUrl":"https://doi.org/10.15406/JACCOA.2021.13.00463","url":null,"abstract":"Background: Patients affected by COVID-19 are at risk of various venous and arterial thrombotic events, as well as embolic risks, the risk can vary from 17% to 78% according to the different published series. Therefore, thromboprophylaxis must be imperative. Methods: Descriptive and analytical study in patients who presented pneumonia due to COVID-19 in April and May 2020, who received LMWH during their hospital stay and at discharge with rivaroxaban 10 mg / day for 2 months. D-dimer was measured at the beginning of the study and 1 month after discharge. Thrombotic or hemorrhagic episodes are controlled after 1 and 2 months of treatment (June – July 2020). Results: 50 patients are included, twenty women (40%) and thirty (60%) men, with a median age of 42.9 years. 32 (64%) patients had mild pneumonia and 18 (36%) patients had severe pneumonia, mean initial d-dimer 556.5 (375.2 - 1233.7) ng / ml, 56% of patients had d-dimer ≥ 500 ng / ml at the time of hospital admission. Baseline D-dimer values were significantly higher among patients with severe pneumonia. In the follow-up at one and two months after hospital discharge, we found that D-dimer values were significantly higher among patients with severe pneumonia and also, in this group of patients, the percentage of patients with D-dimer levels ≥ 500 ng / mL in the first month of follow-up, was significantly higher in the group of patients who were hospitalized for severe pneumonia. During the first month of follow-up, there was a thrombotic event and a hemorrhagic event in the group of patients with a history of severe pneumonia; by the second month of follow-up, there was a hemorrhagic event in the group of patients with mild pneumonia, but this difference in frequencies was not statistically significant. Conclusion: In this group of patients, the incidence of thrombotic and hemorrhagic events was low, so the thromboprophylaxis scheme used in patients with recovered pneumonia due to COVID-19 is recommended. Rivaroxaban is safe to use like thromboprophylaxis.","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84251304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative focused cardiac ultrasound: a brief report.","authors":"Amish Sheth,&nbsp;Anahita Dabo-Trubelja","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The anesthesiologist's emerging role as a perioperative physician has challenged the field to broaden its scope of practice to meet the demands of the patient undergoing surgery today. This brief report aims to identify the indications, clinical impact on management decisions, and perioperative focused cardiac ultrasound accuracy in patients scheduled for non-cardiac surgery.</p><p><strong>Methods: </strong>A review from the Department of Anesthesia Perioperative Echocardiography database on transthoracic echocardiography was performed, including clinical, demographic, indications, therapeutic impact, and accuracy from February 1, 2017 to October 10, 2019.</p><p><strong>Results: </strong>A total of 220 FoCUS exams were identified. FoCUS was performed in 55% males and 45% females. The average age was 66.5 years, and 68% of patients were designated ASA 3 classification. The majority underwent thoracic procedures with a history of cardiovascular disease for hemodynamic instability in the post-anesthesia care unit (PACU). In this group, 94% had a change in management. New findings in 9 patients resulted in pre-induction management change. FoCUS was also performed intraoperatively to differentiated hemodynamic instability, significantly altering care. Postoperatively, new wall motion abnormalities findings escalated care to the cardiology service. Immediate assessment of hemodynamic instability altered care and postoperative recovery location in a significant number of patients. In all cases, FoCUS was used to guide management in the differential diagnosis of the acute event and to assess treatment response.</p><p><strong>Conclusion: </strong>This review demonstrates that FoCUS is an excellent clinical adjunct in the perioperative period. Diagnostic accuracy and efficiency by pattern recognition helped answer clinically significant questions and guide management. The non-invasive approach of POCUS and its rapid adaptation makes it an exciting area of future research.</p>","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"13 1","pages":"55-60"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25575096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID19 and pregnancy- Two lives at risk","authors":"Anie Gupta","doi":"10.15406/jaccoa.2020.12.00452","DOIUrl":"https://doi.org/10.15406/jaccoa.2020.12.00452","url":null,"abstract":"Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is an infectious disease with rapid and efficient human-to-human transmission. Pregnancy is relatively an immunocompromised state, which makes it more vulnerable to infections, thus corona virus infection can be hazardous to both mothers and their fetuses. The management of parturients infected with COVID- 19 requires special considerations, including caring for critically ill pregnant and postpartum women to protecting health care workers from exposure. Therefore preparation and awareness regarding anesthetic management of pregnant women with COVID 19 is paramount. The goal of this review is to update the anesthesiologists caring for parturients during this pandemic and opt for best clinical practice for management of such patients, when evidence is limited.","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85350146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compassionate use of ultrasound-guided bilateral infraclavicular brachial plexus block with phenol in a case of obliterative thromboangitis","authors":"Aréchiga Ornelas Ge","doi":"10.15406/jaccoa.2020.12.00451","DOIUrl":"https://doi.org/10.15406/jaccoa.2020.12.00451","url":null,"abstract":"block by fluoroscopy to promote vasodilation and improve distal irrigation without poor response. A USG-guided suprascapular","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87807589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective ventilation measures improve outcomes during major vascular surgery","authors":"S. Saha, Mark Bazzell, Randall O Dull, V. Nielsen, S. Bhattacharjee, Chiu-Hsieh Hsu, Craig C. Weinkauf","doi":"10.1016/j.jvs.2020.04.079","DOIUrl":"https://doi.org/10.1016/j.jvs.2020.04.079","url":null,"abstract":"","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81892172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional anesthesia: an elegant way to circumvent the “trouble” amidst the COVID 19","authors":"V. Ponde","doi":"10.15406/jaccoa.2020.12.00443","DOIUrl":"https://doi.org/10.15406/jaccoa.2020.12.00443","url":null,"abstract":"","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87859946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful intubation of a treachercollins syndrome patient with ‘STRIVE Hi’ and videolaryngoscopy: a case report","authors":"L. Young, D. Potgieter, C. Roche","doi":"10.15406/jaccoa.2020.12.00441","DOIUrl":"https://doi.org/10.15406/jaccoa.2020.12.00441","url":null,"abstract":"Treacher Collins Syndrome (TCS) is characterised by craniofacial abnormalities which pose a unique airway challenge for anaesthetists. For these patients requiring general anaesthesia and endotracheal intubation, maintaining spontaneous breathing throughout induction should be considered foundational to safety. Spontaneous respiration using intravenous anaesthesia and high-flow nasal oxygen (STRIVE Hi) has been previously shown to safely induce patients with difficult airways. This case demonstrates the first described successful intubation of an adult TCS patient with hyperangulated blade videolaryngoscopy “GlideScopeLoPro S4” using a STRIVE Hi induction technique.","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91533577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In unexpected and sudden blood loss (even if, Hb: 3,5g/dl), which can be seen in Emergency Surgeries, performing necessary and sufficient fluid resuscitation can delay or reduce the need for blood transfusions","authors":"A. Akyol","doi":"10.15406/jaccoa.2020.12.00440","DOIUrl":"https://doi.org/10.15406/jaccoa.2020.12.00440","url":null,"abstract":"Correct communication with the Obstetrics department in emergency obstetric operations is as vital as emergency anesthesia and bleeding management. Clinical communication is of great importance in treatment. In the occurrence of unexpected and sudden blood loss that can be seen in emergency surgeries, performing necessary and sufficient fluid resuscitation can delay or reduce the need for blood transfusion, even if hemoglobin is 3,5g/dl.","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81647525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The patients with posterior reversible encephalopathy syndrome","authors":"A. Akyol","doi":"10.15406/jaccoa.2020.12.00442","DOIUrl":"https://doi.org/10.15406/jaccoa.2020.12.00442","url":null,"abstract":"Posterior Reversible Encephalopathy Syndrome (PRES): is a syndrome that can develop due to eclampsia, preeclampsia, hypertension, drug intoxications and various metabolic diseases. It is a condition with symptoms such as visual impairment, headache, mental disorder, and epileptic seizures, which can improve clinically and radiologically within a few weeks with the elimination of the etiological factor. Vasogenic edema forming in cerebral tissue forms the basis of its pathophysiology. Leakage in cerebral arterioles or vascular endothelial damage due to hyperperfusion have been blamed as the cause of vasogenic edema. Its etiology includes hypertensive encephalopathy, preeclampsia, acute and chronic kidney diseases, immunosuppressive drugs, blood transfusion and electrolyte imbalance.1–6","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84145311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low hyperbaric bupivacaine doses for unilateral spinal anesthesia for open inguinal herniorrhaphy. a pilot study with 20 patients","authors":"L. E. Imbelloni","doi":"10.15406/jaccoa.2020.12.00438","DOIUrl":"https://doi.org/10.15406/jaccoa.2020.12.00438","url":null,"abstract":"Background : Unilateral spinal anesthesia may have advantages over bilateral spinal anesthesia. Low doses of local anesthetic, slow injection speed and lateral position are facilitators to produce unilateral spinal anesthesia. The aim of this study was to perform inguinal hernia repair with unilateral spinal anesthesia and low doses of bupivacaine associated with morphine in a pilot study with 20 patients. Material and methods : Spinal anesthesia with 0.5% bupivacaine and 26G Quincke needle was induced in a prospective pilot study in 20 patients physical status ASA I-II submitted to inguinal hernia repair. Spinal puncture was performed with patients previously placed with the side to be operated on facing downward and 5 mg of 0.5% hyperbaric bupivacaine plus 80 µg of morphine were injected at 1 mL/30 s. Sensory and motor blocks (pinprick and 0 to 3 scores) were compared between operated and contralateral sides. Hemodynamic changes, nausea and vomiting, pruritus and urinary retention were evaluated. Results : All 20 patients were operated on using the technique employed, with no need for supplementation with sedation or general anesthesia. Unilateral block was induced in 100% of patients at 15 minutes and the end of the surgery. There has been hemodynamic stability in all patients. Urinary retention occurred in 8 patients (40%), pruritus in 4 patients (20%) and nauseas and vomiting in 4 patients (20%). No patient has developed post dural puncture headache. Conclusion: This prospective pilot study with 0.5% hyperbaric bupivacaine (5mg) associated with morphine (80 µg) has provided predominantly unilateral block. Fifteen minutes were enough for blockade installation. Major unilateral spinal anesthesia advantages are hemodynamic stability, patients ’satisfaction and faster anesthetic recovery.","PeriodicalId":14916,"journal":{"name":"Journal of Anesthesia & Critical Care: Open Access","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76267546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}