Survey of Anesthesiology最新文献

{"title":"Monkey in the Middle: Translational Studies of Pediatric Anesthetic Exposure.","authors":"M. Baxter, M. Alvarado","doi":"10.1097/01.sa.0000525615.53047.aa","DOIUrl":"https://doi.org/10.1097/01.sa.0000525615.53047.aa","url":null,"abstract":"P reclinical animal studies have resulted in retrospective and prospective studies in humans regarding the safety of pediatric anesthesia. The possibility of adverse neurocognitive outcomes associated with repeated or prolonged pediatric anesthesia is worrisome. The latest investigation by Coleman et al also investigates the impact of exposure to general anesthesia in infancy on neurobehavioral development in nonhuman primates. This is a translationally relevant model as the stage of brain development at birth of a rhesus monkey is similar to that of a 6-month-old human infant. Also, physiologicmonitoring and support are more viable in the case of an infant monkey rather than with an infant rodent. Hence, the study by Coleman et al provides","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81847951","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":"Impact of Focused Intraoperative Transthoracic Echocardiography by Anaesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients","authors":"T. Kratz, T. Steinfeldt, M. Exner, M. C. DellʼOrto, N. Timmesfeld, C. Kratz, M. Skrodzki, H. Wulf, M. Zoremba","doi":"10.1097/01.sa.0000525647.48445.c1","DOIUrl":"https://doi.org/10.1097/01.sa.0000525647.48445.c1","url":null,"abstract":"Perioperative hemodynamic monitoring and intervention using transthoracic echocardiography (TTE) in highrisk surgery patients can decrease the rates of adverse events, morbidity, and mortality; however, evidence regarding its benefits is required. This prospective interventional study aimed at evaluating the efficacy of intraoperative TTE to alter patient management in high-risk and extensively monitored surgical patients susceptible to hemodynamic instability. The study included 52 hemodynamically unstable high-risk abdominal, vascular, or thoracic surgery patients. Patients were anesthetized, and focused TTE was performed when intraoperative hemodynamic instability occurred (hypotension or low cardiac output for a period of ≥3 minutes). Cardiac output monitoring system using pulse contour analysis was established before induction of anesthesia. The definitive therapy leading to an alteration of management was guided by the results of the focused TTE. Differences between intended and actual therapies and changes in management were documented as the primary end points. The analysis of TTE quality and description of pathophysiologic cardiovascular findings were the secondary end points. Sample size estimation and statistical analyses were performed with the statistical software R (www.r-project.org). Changes of management were noted in 33 patients (66%; 95% confidence interval, 52.11%–77.61%) and 38 hemodynamic situations (46.34%; 95% confidence interval, 35.95%–57.06%) of the 50 hemodynamically unstable patients examined by additional focused TTE. Transthoracic echocardiography identified pathologic findings in 47 patients: hypovolemia (66%), left ventricular dysfunction (8%), right ventricular overload (22%), and right-sided heart failure (4%). Lack of randomization and the absence of a control group were the major limitations of this study.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84837991","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":"Transthoracic echocardiography and electrical cardiometry elucidate the hemodynamics of autotransfusion during labor under epidural analgesia.","authors":"T. Archer","doi":"10.1097/SA.0000000000000334","DOIUrl":"https://doi.org/10.1097/SA.0000000000000334","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86589038","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":"Vasopressin, Norepinephrine, and Vasodilatory Shock After Cardiac Surgery: Another “VASST” Difference?","authors":"J. Russell","doi":"10.1097/01.sa.0000525623.85327.92","DOIUrl":"https://doi.org/10.1097/01.sa.0000525623.85327.92","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78399978","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":"Context is king - obstetric anaesthesia management strategies in limited resource settings.","authors":"D. Bishop, R. Rodseth, R. A. Dyer","doi":"10.1097/01.sa.0000527498.71626.89","DOIUrl":"https://doi.org/10.1097/01.sa.0000527498.71626.89","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73897457","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":"Accuracy and Precision of Non-invasive Cardiac Output Monitoring Devices in Perioperative Medicine: A Systematic Review and Meta-analysis","authors":"A. Joosten, O. Desebbe, K. Suehiro, L. Murphy, M. Essiet, B. Alexander, M. Fischer, L. Barvais, L. Obbergh, D. Maucort-Boulch, M. Cannesson","doi":"10.1097/SA.0000000000000319","DOIUrl":"https://doi.org/10.1097/SA.0000000000000319","url":null,"abstract":"The main purpose of this article is to provide a systematic review of all medical literature (37 studies; 1543 patients) comparing cardiac output (CO) measured with a commercially available completely noninvasive CO monitoring device against bolus thermodilution (TD) in various clinical settings such as the intensive care unit, emergency department, and the operating room. In addition, the authors provide a meta-analysis of the data extracted from the systematic review to calculate the precision of these noninvasive CO monitoring devices when used perioperatively by following pooled estimates. The authors gathered data from the systematic review in order to calculate the following 4 variables: (1) the pooled estimate of the mean difference between the tested method of bolus TD and the noninvasive reference method (bias), (2) the pooled estimate of the standard deviation (precision) of the bias, (3) the pooled estimate of the 95% confidence intervals of the bias, and (4) the pooled estimate of the percentage of error (PE). An acceptable agreement between the tested and the reference method was defined as a pooled estimate (PE) of 30% or greater. Despite it being crucial in critical care management, CO, the basis of measuring oxygen delivery to end organs, has been demonstrably undermonitored in clinical settings. New noninvasive techniques and older methods abound for monitoring CO including pulse wave transit time (PWTT), noninvasive pulse contour analysis (niPCA), partial CO2 rebreathing (CO2r), and thoracic electrical bioimpedance (TEB), yet the “go-to” in the clinical setting is the traditional invasive technique of bolus TD. Mean CO was 4.78 L/min in both methods. The overall random-effects pooled bias was −0.13 L/min (−2.38 to 2.12 L/min) and PE 47% with high interstudy sensitivity heterogeneity (I = 83%, P < 0.001). Despite the many advances in medical technology since the early 2000s, both TEB and CO2r have not shown significantly increased agreement when compared with bolus TD (PE for TEB was 37% in 1999, 43% in 2010, and 42% in 2016 in this metaanalysis; CO2r PE was similar to 2010: 44.5% against 40% in this meta-analysis). Recent techniques, such as PWTTand the niPCA, have a PE of 62% for PWTT and 45% for niPCA. Completely noninvasive technologies for the measurement of CO did not reach an acceptable level of agreement. The PEs of all noninvasive techniques were above the preset threshold of 30%, and the","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78737138","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":"Preoperative Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers: Do We Have Enough “VISION” to Stop It?","authors":"M. London","doi":"10.1097/01.sa.0000525653.70599.b4","DOIUrl":"https://doi.org/10.1097/01.sa.0000525653.70599.b4","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76716683","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":"Innovative Disruption in the World of Neuromuscular Blockade: What Is the “State of the Art?”","authors":"M. Naguib, Ken Johnson","doi":"10.1097/01.SA.0000525660.70880.8D","DOIUrl":"https://doi.org/10.1097/01.SA.0000525660.70880.8D","url":null,"abstract":"morbidity. The risks associated with NMBA could be almost completely eliminated if adequate neuromuscular function measured by a TOF ratio of greater than 0.90 was obtained before allowing emergence from anesthesia and tracheal extubation. Hence, neuromuscular function assessment with a PNS is mandatory whenever either depolarizing or nondepolarizing NMBAs are used to reduce risk of residual block.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80657230","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":"Implementing a Statistical Model for Protamine Titration: Effects on Coagulation in Cardiac Surgical Patients","authors":"Oskar Hällgren, S. Svenmarker, M. Appelblad","doi":"10.1097/01.sa.0000525620.39586.68","DOIUrl":"https://doi.org/10.1097/01.sa.0000525620.39586.68","url":null,"abstract":"as tramadol pharmacology will ensure the optimal pain management without adverse effects or toxicity. The possibility of misuse, withdrawal symptoms, and adverse effects are greater in the case of tramadol because of its unique simultaneous opioid agonist action and serotonin and norepinephrine reuptake inhibitory effects, which increases the potential for drug interactions. A more thorough understanding of tramadol's pharmacology and pharmacokinetics including the effect of CYP genetic polymorphisms will ensure more targeted prescribing practices. In addition, both patients and practitioners should be aware of the potential for drug interactions, possibility of addiction, toxicity risks, and risk of withdrawal. Hopefully, increased knowledge in these areas will improve the possibility of making an optimal decision regarding the use of this drug.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"10 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78218037","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":"Prospective Double Blind Randomized Placebo-Controlled Clinical Trial of the Pectoral Nerves (Pecs) Block Type II","authors":"B. Versyck, G. Geffen, P. V. Houwe","doi":"10.1097/SA.0000000000000338","DOIUrl":"https://doi.org/10.1097/SA.0000000000000338","url":null,"abstract":"STUDY OBJECTIVE The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery. DESIGN A prospective randomized double blind placebo-controlled study. SETTING A secondary hospital. PATIENTS 140 breast cancer stage 1-3 patients undergoing mastectomy or tumorectomy with sentinel node or axillary node dissection. INTERVENTIONS Patients were randomized to receive either a Pecs block with levobupivacaine 0.25% (n=70) or placebo block with saline (n=70). MEASUREMENTS The pain levels were evaluated by Numeric Rating Scale (NRS) pain scores at 15-minute intervals during the post anesthesia care unit stay time (PACU), at 2-hour intervals for the first 24h on the ward and at 4-hour intervals for the next 24h. Intraoperative and postoperative opioid consumption were recorded during the full stay. Patient satisfaction was evaluated upon discharge using a 10-point scale. MAIN RESULTS Intraoperative sufentanil requirements were comparable for the Pecs and placebo group (8.0±3.5μg and 7.8±3.0μg, P=0.730). Patients in the Pecs group experienced significantly less pain than patients in the control group (P=0.048) during their PACU stay. Furthermore, patients in the Pecs group required significant less postoperative opioids (9.16±10.15mg and 14.97±14.38mg morphine equivalent, P=0.037) and required significant fewer postsurgical opioid administration interventions than patients in the control group (P=0.045). Both patient-groups were very satisfied about their management (9.6±0.6 and 9.1±1.8 on a 10-point scale, P=0.211). CONCLUSIONS The Pecs block reduces postsurgical opioid consumption during the PACU stay time for patients undergoing breast surgery.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78631093","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}