Journal of Anesthesia and Perioperative Medicine最新文献

{"title":"Astragalus Pretreatment but Not Posttreatment Reduces Hemorrhagic Shock-Induced Intestinal Injury in a Rat Model","authors":"Yu Gu, Jiaxin Chen, N. Cheng, Dezhao Liu, Mian Ge, Chaojin Chen, Z. Hei","doi":"10.24015/japm.2017.0192","DOIUrl":"https://doi.org/10.24015/japm.2017.0192","url":null,"abstract":"","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"1 1","pages":"237-242"},"PeriodicalIF":0.0,"publicationDate":"2017-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79454481","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 Glycemia Control: Have We Reached the Target?","authors":"Qian Ding, Li-nong Yao, J. Goldhammer, Hong Liu, Jianzhong Sun","doi":"10.24015/JAPM.2017.0083","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0083","url":null,"abstract":"","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"74 1","pages":"282-290"},"PeriodicalIF":0.0,"publicationDate":"2017-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83500084","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":"Patient-Reported Outcome Measures (PROM) as A Preoperative Assessment Tool","authors":"SungHyek Kim, P. Duncan, L. Groban, Hannah Segal, R. M. Abbott, J. Williamson","doi":"10.24015/JAPM.2017.0081","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0081","url":null,"abstract":"Aim of review Patient-reported outcomes (PRO) on functional, social, and behavioral factors might be important preoperative predictors of postoperative outcomes. We conducted a literature review to explore associations of preoperative depression, socioeconomic status, social support, functional status/frailty, cognitive status, self-management skills, health literacy, and nutritional status with surgical outcomes. Methods Two electronic data bases, including PubMed and Google Scholar, were searched linking either depression, socioeconomic status, social support, functional status/frailty, cognitive status, self-management skills, health literacy, or nutritional status with surgery, postoperative complications, or perioperative period within the past 2 decades. Recent findings Preoperative depression has been linked to postoperative delirium, complications, persistent pain, longer lengths of stay, and mortality. Socioeconomic status associates with overall and cancer-free survival. Low socioeconomic status has also been connected to medication non- compliance. Social support can predict overall and cancer- free survival, as well as physical, social and emotional quality of life. Poor functional status and frailty have been related to postoperative complications, longer lengths of stay, post-discharge institutionalization, and higher costs. Preoperative cognitive impairment also associates with self-medication management errors, postoperative cognitive impairment, delirium, complications and mortality. In addition, a greater tendency for reduced adherence to preoperative medication instructions has been linked to health illiteracy. Preoperative malnutrition is prevalent and associates with postoperative morbidity. Conclusion Efficient and effective assessments of social and behavioral determinants of health, functional status, health literacy, patient’s perception of health, and preferences for self-management may improve postoperative management and surgical outcomes, particularly among vulnerable patients undergoing elective surgery who might have subtle physical, social, or psychological deficits or challenges, otherwise missed upon routine evaluation. Patient Reported Outcome Measures (PROMs) can be used to effectively and efficiently collect these factors in the preoperative period, thereby identifying areas that can be intervened preemptively. (Partially Funded by the National Institute on Aging and the Wake Forest University Claude D. Pepper Older Americans Independence Center.)","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"3 1","pages":"274 - 281"},"PeriodicalIF":0.0,"publicationDate":"2017-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82352631","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":"Use of Point-of-Care Ultrasonography in Simulation-Based Advanced Cardiac Life Support Scenarios","authors":"Stephanie Cha, A. Gottschalk, E. Su, A. Schiavi, Adam Dodson, A. Pustavoitau","doi":"10.24015/JAPM.2017.0058","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0058","url":null,"abstract":"Background: Ultrasonography is an effective tool for diagnosing potential reversible aetiologies of cardiac arrest. We developed an educational curriculum for critical care ultrasonography involving multiple sequential cardiac arrest simulation scenarios and assessed the efficacy of participants’ performance. Methods: Didactic lectures and hands-on training sessions were provided before participants were divided into simulation teams for a series of five scenarios in which they were instructed to utilize ultrasonography during ongoing advanced cardiac life support (ACLS). Simulation sessions were videotaped and subsequently reviewed for extraction of parameters relating to ACLS adherence and performance of point-of-care ultrasonography examination. The primary outcome was duration of no-flow interval (NFI), the period during which chest compressions are halted and ultrasound examination is typically performed.  We also collected data on NFI score (based on simulation team performance during NFI), time from arrest to first chest compressions, time from arrest to defibrillation, and other parameters describing team performance. Results: Fifty-five course participants comprised 12 simulation teams.  For all participants, the average NFI was 22.2 s (95% CI, 19.1-25.2) during scenario 1, with declines in duration thereafter (P ≤ 0.004). In subsequent scenarios, an increasing proportion of NFI occurred within the interval of 10 s (P = 0.018).   Conclusion: Simulation is an effective teaching modality for critical care ultrasonography. Novice ultrasound users can be taught to perform point-of-care ultrasonography effectively during simulated cardiopulmonary arrest in an ACLS-compliant manner, a finding that may have significant implications for the clinical management of in-hospital cardiac arrest. (Funded by the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, and Johns Hopkins Medicine Simulation Center.)     Citation: Stephanie Cha, Allan Gottschalk, Erik Su, Adam Schiavi, Adam Dodson, Aliaksei Pustavoitau. Use of Point-of-Care Ultrasonography in Simulation-Based Advanced Cardiac Life Support Scenarios. J Anesth Perioper Med 2017; 4 : x- xx. doi: 10.24015/ JAPM.2017.0058 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"16 1","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2017-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88151948","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":"Dealing with Traumatic Coagulopathy: A Long Way to Go","authors":"F. Hua, Wang Tian-long","doi":"10.24015/JAPM.2017.0055","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0055","url":null,"abstract":"Traumatic coagulopathy is a complicated pathophysiological process. The management of traumatic coagulopathy should cover the whole process from pre-hospital to after discharge. The recommendations on management of coagulopathy following trauma in this guideline are practical, but there are still many circumstances we don’t know how to deal with. To manage traumatic coagulopathy, we believe that there is still a long way to go.   Citation: Hua Feng, Tian-Long Wang. Dealing with Traumatic Coagulopathy: A Long Way to Go. J Anesth Perioper Med 2017; 4: 195-7. doi:10.24015/JAPM.2017.0055 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"18 1","pages":"195-197"},"PeriodicalIF":0.0,"publicationDate":"2017-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81281792","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":"Activation of NF-κB Signal Pathway and Downstream IL-1β Expression in Hippocampal Astrocytes of LPS-Induced Aged Rats","authors":"Kan Min-Hui, Fu Hui-qun, F. Long, W. Yan, Wang Tian-long","doi":"10.24015/JAPM.2017.0051","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0051","url":null,"abstract":"Background: The activation of nuclear factor-kappa B (NF-κB) signal pathway and downstream expression of IL-1β may play a pivotal role in neuroinflammation and cognitive dysfunction. We previously reported that a single lipopolysaccharide (LPS) dose induces prolonged neuroinflammation which is associated with astrocytic NF-κB signal pathways in aged rats. Blockade of the pathway by pyrrolidine dithiocarbamate (PDTC) in astrocytes could markedly suppress them, which may provide innovative ideas for clinical improvement for postoperative cognitive dysfunction (POCD). Methods: Rats were randomly assigned to vehicle, LPS, LPS+PDTC groups (n = 8 per group, per time point). 1) vehicle control (0.9% NaCl i.p.), 2) LPS (2 mg/kg i.p), 3) LPS + PDTC (LPS and PDTC50 mg/kg i.p.). After injection, whole brain tissues acquired at a series of time points (days 1, 3,7, 15 and 30) was prepared to carry out immunofluorescence, isolated hippocampal tissues were used for enzyme-linked immunosorbent assay (ELISA). NF-κB p65, p-IκBα and IL-1β were detected respectively by immunofluorescence and IL-1β protein levels were determined by ELISA. A separate cohort of rats (n=8-10/group) were tested in a Morris water maze (MWM) for spatial learning and memory. Results: The PDTC treatment suppressed the LPS-induced canonical NF-κB signaling pathway- nuclear translocation of NF-κB p65 and IκBα phosphorylation, positive expression of GFAP and IL-1β in hippocampal astrocytes of aged rats by immunofluorescence and reduced cognitive dysfunction by MWM test; The LPS-induced IL-1β protein increase in hippocampus of aged rats was attenuated by PDTC with ELISA. Conclusion: These findings suggest that NF-κB signaling pathway and downstream IL-1β in senescent astrocytes may play important roles in age-related neuroinflammation and cognitive dysfunction and provide potential discovery tool and therapeutic methods with PDTC for verifying the NF-κB signal pathway and treating cognitive impairment, especially POCD. (Funded by National Clinical Research for Geriatric Disorders of China, and Beijing Municipal Administration of Hospitals' Ascent Plan.)     Citation: Min-Hui Kan, Hui-Qun Fu, Long Fan, Yan Wu, Tian-Long Wang. Activation of NF-κB Signal Pathway and Downstream IL-1β Expression in Hippocampal Astrocytes of LPS-Induced Aged Rats. J Anesth Perioper Med 2017; 4 : 149-61. doi: 10.24015/ JAPM.2017.0051 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"11 1","pages":"149-161"},"PeriodicalIF":0.0,"publicationDate":"2017-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88596820","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":"Fluid Responsiveness Assessment Using Passive Leg Raising Test to Reduce Fluid Administration and Weight Gain in Patients with Septic Shock","authors":"C. Maria, Bergman Magnus, Joelsson-Alm Eva, Divander Mona-Britt, J. Emma, Balintescu Anca, M. Johan, Svensen Christer","doi":"10.24015/JAPM.2017.0049","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0049","url":null,"abstract":"Background: Several observational studies have demonstrated an association between fluid accumulation and mortality in sepsis. Our aim was to determine if assessment of fluid responsiveness by a passive leg raising (PLR) algorithm could reduce fluid accumulation after 3 days in the intensive care unit (ICU) in patients with septic shock. Methods: This was an open-label single-centre randomised clinical trial performed in a surgical ICU in a tertiary centre in Stockholm, Sweden. We randomised adult (>18 years) patients with septic shock admitted to the ICU to a PLR group or a standard of care group. An increase in stroke volume index of at least 10% on the PLR test was required for the clinician to administer a fluid bolus to patients in the PLR group.  Results: We randomised 34 patients. The mean (SD) weight gain after three full ICU-days was 0.6 ± 3.2 kg in the PLR group and 1.3 ± 3.9 kg in the control group (P = 0.59). The median (IQR) amount of administered resuscitation fluid during the study period was 2103 (1283-2645) ml in the PLR group and 2408 (954-5045) ml in the control group (P = 0.38). We could implement a protocol that required a positive PLR-test before administration of resuscitation fluids, but recruitment rate was low. The trial was terminated early for futility.  Conclusion: The PLR protocol was not meaningful in our clinical setting, as weight gain was already low in the control group. To increase feasibility of a trial which implements a PLR-test we recommend using a non-invasive hemodynamic measurement, to include restriction of maintenance fluids in the protocol and to investigate the level of weight gain in the setting where the trial is to be performed before the start of the trial. (Funded by Stockholm County Council; ClinicalTrials.gov number, NCT02301585.)    Citation:  Maria Cronhjort, Magnus Bergman, Eva Joelsson-Alm, Mona-Britt Divander, Emma Jerkegren, Anca Balintescu, et al. Fluid Responsiveness Assessment Using Passive Leg Raising Test to Reduce Fluid Administration and Weight Gain in Patients with Septic Shock. J Anesth Perioper Med 2017; 4 : 169-78. doi: 10.24015/ JAPM.2017.0049 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"23 1","pages":"169-178"},"PeriodicalIF":0.0,"publicationDate":"2017-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88240593","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":"Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know!","authors":"F. Xue, Yayang Liu, Hui-xian Li, Guizhen Yang","doi":"10.24015/JAPM.2017.0048","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0048","url":null,"abstract":"Aim of review: The aim of this article is to convey several hotspot issues regarding the use of videolaryngoscopy (VL) in airway management that anesthesiologists are often concerned. Methods: Recent literature in the past 20 years about the use of VL in the clinical airway management were searched from the Pubmed and Cochrane databases and reviewed, in order to determine the strengths and weakness of VL and conflicting issues regarding the role of VL in airway management. Recent findings: The benefits of VL are most significant in patients with difficult airways, with an improved laryngeal view and an increased success rate of intubation. However, VL cannot give a 100% success rate and there is no specific evaluation system of difficult or failed VL as with direct laryngoscopy. Awake VL-assisted intubation is a useful alternative to awake fiberoptic intubation, but the fiberoptic bronchoscope cannot be discarded and still is gold standard tool of difficult airway management. There are several different-type VLs available and their efficacies may be different between devices due to various designs and shapes. Due to the limited number of comparative studies, however, there is inconclusive evidence to recommend which VL design is more advantageous in various clinical situations. A Macintosh-type VL allows residents to learn laryngoscopy and intubation more quickly and effectively. Given that VL has tremendous advantages, it should be used as the first-line device for all tracheal intubations. Summary: The introduction of VL has resulted in a dramatic transformation of clinical airway management and is seen as the evolutionary step in intubation technology. There are considerable disagreements over the role of VL in airway management and the need of more investigation, but VL continues to get popularity both inside and outside the operating room. With increasing use of VL in airway management, experience and skill will undoubtedly increase, and the evidence will suggest that the attempt numbers and complications of intubations may be decreased, and patient safety can be improved. (Funded by the Major Project of Zhejiang Science and Technology Fund.)    Citation:  Fu-Shan Xue, Ya-Yang Liu, Hui-Xian Li, Gui-Zhen Yang. Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know! J Anesth Perioper Med 2017; 4 : x-xx. doi: 10.24015/JAPM.2017.0048 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"13 1","pages":"23-33"},"PeriodicalIF":0.0,"publicationDate":"2017-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77691738","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":"Intra-Aortic Balloon Occlusion for Pelvic and Sacrum Tumors: A Case Series","authors":"K. Sun, Y. Huo, Yong Xu, Feng-jiang Zhang, Shui Yu, Zhen-feng Zhou, Lina Yu, M. Yan","doi":"10.24015/JAPM.2017.0029","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0029","url":null,"abstract":"Background: The purpose of this study is to investigate feasibilities of intra-aortic balloon occlusion (IABO) for pelvic and sacrum tumors, focusing on the advantages and precautions of the technique. Methods: From January 2010 to December 2013, among all patients with sacrum or pelvic tumor, 46 underwent surgery adjuvant with IABO. We retrospectively reviewed the medical records of these patients, including characteristics, intraoperative hemorrhage, transfusion, serum potassium, arterial lactic acid, postoperative complication, tumor recurrence or metastasis at a follow-up of 28.2 months. Results: Balloons for 46 patients were successfully placed, and the average intraoperative hemorrhage was 1.8 (1.2-3.0) l. Intraoperatively, arterial lactic acid increased from baseline (1.69±0.68) mmol/l to (2.11±0.82) mmol/l (P=0.17) during occlusion and (3.50±2.70) mmol/l (P=0.02) after deflation. While serum potassium concentration showed a trend of increase, but the change was not significant. Application of the technique helped create a bloodless surgical field and shorten the operative time. 9 patients regained normal defecation, while 2 patients with preoperative numbness of perineum developed new onset urinary and fecal incontinence after surgery. Postoperatively, 5 patients developed wound infection, 1 patient developed lower limb weakness, and 1 patient developed cerebrospinal leak. During 28.2 months' follow-up, 5 recurrences and 2 metastases occurred.  Conclusions: IABO might be a choice to reduce intraoperative bleeding, create a clear view of the anatomical structures, shorten the operative time and limit postoperative complication in resection of pelvic and sacrum tumor. Nevertheless, anesthesiologists and surgeons should be sensitive to hemodynamic parameters, electrolyte balance as well as acid-base balance during the procedure, especially after deflation of the balloon.    Citation: Kai Sun, Yang-Fan Huo, Yong Xu, Feng-Jiang Zhang, Shui Yu, Zhen-Feng Zhou, et al. Intra-Aortic balloon occlusion for pelvic and sacrum tumors: a case series. J Anesth Perioper Med 2017; x: x-x.  doi:10.24015/JAPM.2017.0029 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"2006 1","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"2017-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78878253","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":"Delay in Diagnosis of Vertebrobasilar Insufficiency: The Masking Effect of Headache and Coexisting Pain Syndromes","authors":"Daryl I Smith, Svetlana Pyatigorskya, N. Tran","doi":"10.24015/japm.2017.0019","DOIUrl":"https://doi.org/10.24015/japm.2017.0019","url":null,"abstract":"Headaches of vascular and other origins can develop in the midst of work-ups for benign, long-standing pain conditions. The initial attribution of these headaches to benign conditions in the early evaluative process, especially when non-life threatening signs and symptoms are present, is not only frequently plausible but most often correct. Given the frequency with which patients present with a complaint of headache, constant vigilance and re-examination is required to prevent potentially life-threatening conditions from being overlooked as they develop. This case report describes a patient presentation that should serve as a cautionary tale for such a circumstance. Common, concurrent maladies were diagnosed and treated with varying degrees of success, yet the evolution of a potentially life-threatening disease with very similar symptomatology occurred in the midst of the workup.  We believe this description will prove of value to established clinicians in their everyday practices, as well as to trainees as they study differential diagnoses.  Citation: Daryl Irving Smith, Svetlana Pyatigorskya, Nobuyuki-Hai Tran. Delay in diagnosis of vertebrobasilar insufficiency: the masking effect of headache and coexisting pain syndromes. J Anesth Perioper Med 2017; 4: 231-6. doi:10.24015/JAPM.2017.0019This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"4 1","pages":"231-236"},"PeriodicalIF":0.0,"publicationDate":"2017-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86240456","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}