Survey of Anesthesiology最新文献

{"title":"Obstetric Interventions and Maternal Morbidity Among Women Who Experience Severe Postpartum Hemorrhage During Caesarean Delivery","authors":"K. Seligman, B. Ramachandran, Priya Hegde, E. Riley, Y. El‐Sayed, Lorene M. Nelson, A. Butwick","doi":"10.1097/01.sa.0000527499.79249.cc","DOIUrl":"https://doi.org/10.1097/01.sa.0000527499.79249.cc","url":null,"abstract":"Postpartum hemorrhage (PPH) causes severe maternal morbidity and mortality in women undergoing cesarean delivery (CD) compared to women undergoing vaginal delivery. The planning and management of PPH varies according to whether PPH occurs during prelabor CD or intrapartum CD. This study examined the rates of blood product utilization, medical and surgical intervention and maternal morbidity after severe PPH in the prelabor CD and intrapartum CD populations. The study was a retrospective analysis of data from cesarean deliveries at a tertiary obstetric center between 2002 and 2012. Rate of blood product utilization was the primary outcome of this study, and the secondary outcomes were medical and surgical interventions and hemorrhage-related maternal morbidity. The study population was divided into two CD cohorts: prelabor CD and intrapartum CD that experienced severe PPH. Patients were identified as suffering from severe PPH if the documented estimated blood loss (EBL) was ≥1500 mL or if a red blood cell (RBC) transfusion was administered during CD or within 48 h after CD. Blood component use, medical and surgical intervention and maternal morbidity were reviewed. Statistical analyses were performed using STATA (statistical software package) version 12 and a P <0.05 was considered statistically significant. The study data comprised of 269 prelabor women and 278 intrapartum CD women. For the prelabor cohort, RBC transfusion was used intraoperatively or within 48 h post-CD in 148 (55%) patients. Prelabor CD cases had higher rates of morbidity, including hysterectomy (18%) and the need for ICU admission (16%). For the prelabor CD group with severe PPH, abnormal placentation was contributing in 72% of cesarean hysterectomies and 49% of ICU admissions. In the intrapartum CD cohort, a lower proportion of women received RBCs during the intraoperative period compared to the postoperative period (18.3% vs. 43.9%, respectively; P < 0.001). In this review, methylergonovine was the most commonly used second line uterotonic in both groups. In conclusion, the transfusion rates were relatively high for women with severe PPH during prelabor or intrapartum CD. This data is reflective of current transfusion and surgical practices for management of severe PPH during prelabor and intrapartum CD. Large pragmatic studies are essential for comparing the effects of different PPH interventions on maternal outcomes.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"298 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76487406","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":"Obstetric Anesthesia I.V. Paracetamol as an Adjunct to Patient-Controlled Epidural Analgesia With Levobupivacaine and Fentanyl in Labour: A Randomized Controlled Study","authors":"K. Gupta, S. Mitra, S. Kazal, R. Saroa, V. Ahuja, P. Goel, G. Lim, J. M. Horowitz, S. Berggruen, L. M. Ernst, R. L. Linn, B. Hewlett, J. Kim, L. Chalifoux, R. McCarthy","doi":"10.1097/01.sa.0000515848.92294.ba","DOIUrl":"https://doi.org/10.1097/01.sa.0000515848.92294.ba","url":null,"abstract":"The purpose of this study was to explore the role of intravenous (IV) paracetamol in intrapartum pain relief. This randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital in India assessed optimization of pain control through use of IV paracetamol as an adjunct analgesic agent during labor. Two groups (n = 40 each) of parturients (18–35 years old) with spontaneous onset of labor at term (37–42 weeks’ gestation), cervical dilatation of 5 cm, and a single live fetus in cephalic presentation were randomized. They then received either 1000 mg (100 mL) IV paracetamol or 100 mL normal saline 30 minutes before epidural placement. All 80 patients then received 10 mL of epidural levobupivacaine 0.1% with 2 μg/mL fentanyl, followed by continuous epidural infusion of 6 mL/h with a patient-controlled epidural-administered bolus of 5 mL of the same drug with a lockout interval of 12 minutes. It was found that IV paracetamol reduced epidural fentanyl and levobupivacaine use with similar pain scores. Both the hourly mean drug consumption and the mean number of boluses were markedly lower in the paracetamol group. The primary outcomewas mean hourly drug consumption, whichwas significantly lower in the paracetamol group (7.03 [SD, 0.83]mL; range, 5.77–8.75 mL) as compared with the placebo group (8.12 [SD, 1.34]mL; range, 6.00–11.70 mL; P < 0.001). There was also a lower total number of boluses in the paracetamol group (mean, 1.00 [SD, 0.93]; interquartile range, 0–2) than in the placebo group (mean, 1.43 [SD, 0.90]; interquartile range, 1–3; P = 0.036). These findings support the use of paracetamol in labor analgesia. The use of IV paracetamol as an adjunct to a labor analgesia regimen is safe and significantly reduces patient-controlled epiduraladministered local anesthetic/opioid consumption.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78722693","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":"Anesthesia Kills Brain Cells, but What Does It Mean?","authors":"J. Sall","doi":"10.1097/SA.0000000000000299","DOIUrl":"https://doi.org/10.1097/SA.0000000000000299","url":null,"abstract":"no difference in the percentage of GFP-positive granule cells that coexpressed either Ki67 or calretinin 60 days after exposure, indicating active proliferation of granule cell progenitors following anesthesia exposure. The number of GFP-expressing ectopic cells in the hilus and molecular layer was similar between groups, indicating normal migration patterns in cells born after anesthesia treatment. The results also confirmed that no difference was observed in the rate of cell proliferation of the hippocampus between isoflurane-treated animals and controls either 2 weeks or 2months after exposure. In conclusion, this study confirms that a short anesthetic exposure can cause increased apoptotic cell death in developing brains, but the rate of neurogenesis was unaffected, indicating that the murine hippocampus can regenerate the lost cells when compared with other regions of the brain that may show permanent neuron loss. But more subtle changes in neuronal structure or function may still occur in dentate, and this area requires further research.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82493202","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":"Timing of Intubation and Clinical Outcomes in Adults With Acute Respiratory Distress Syndrome","authors":"K. Kangelaris, L. Ware, Chen Yu Wang, D. Janz, H. Zhuo, M. Matthay, C. Calfee","doi":"10.1097/01.sa.0000504594.01435.d1","DOIUrl":"https://doi.org/10.1097/01.sa.0000504594.01435.d1","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89491927","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":"Comparison of Resistive Heating and Forced-Air Warming to Prevent Inadvertent Perioperative Hypothermia","authors":"M. John, D. Crook, K. Dasari, F. Eljelani, A. El-Haboby, C. Harper","doi":"10.1097/01.sa.0000504596.04838.dd","DOIUrl":"https://doi.org/10.1097/01.sa.0000504596.04838.dd","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88009711","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":"Venous thrombotic, thromboembolic, and mechanical complications after retrievable inferior vena cava filters for major trauma.","authors":"Kwok M. Ho, Kwok M. Ho, J. A. Tan, Maxine Burrell, Sudhakar Rao, P. Misur","doi":"10.1097/SA.0000000000000272","DOIUrl":"https://doi.org/10.1097/SA.0000000000000272","url":null,"abstract":"BACKGROUND\u0000The ideal thromboprophylaxis in patients at risk of bleeding is uncertain. This retrospective cohort study assessed the risk factors for complications after using retrievable inferior vena cava (IVC) filters for primary or secondary thromboembolism prophylaxis in patients after major trauma.\u0000\u0000\u0000METHODS\u0000Using data from radiology, trauma and death registries, the incidence of and risk factors for subsequent deep venous thrombosis (DVT), venous thromboembolism (VTE), and mechanical complications related to retrievable IVC filters in patients, admitted between 2007 and 2012, were assessed in a single trauma centre.\u0000\u0000\u0000RESULTS\u0000Of the 2940 major trauma patients admitted during the study period, a retrievable IVC filter was used in 223 patients (7.6%). Thirty-six patients (16%) developed DVT or VTE subsequent to placement of IVC filters (median 20 days, interquartile range 9-33), including 27 with lower limb (DVT), 8 upper limb DVT, and 4 pulmonary embolism. A high Injury Severity Score, tibial/fibular fractures, and a delay in initiating pharmacological thromboprophylaxis after insertion of the filters (14 vs 7 days, P=0.001) were significant risk factors. Thirty patients were lost to follow-up (13%) and their filters were not retrieved. Mechanical complications-including filters adherent to the wall of IVC (4.9%), IVC thrombus (4.0%), and displaced or tilted filters (2.2%)-were common when the filters were left in situ for >50 days.\u0000\u0000\u0000CONCLUSIONS\u0000A delay in initiating pharmacological thromboprophylaxis or filter removal were associated with an increased risk of subsequent DVT, VTE, and mechanical complications of retrievable IVC filters in patients after major trauma.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83626604","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":"Long-term Outcome Following Tracheostomy in Critical Care: A Systematic Review","authors":"G. Dempsey, B. Morton, C. Hammell, Lisa Williams, Catrin Tudur Smith, T. Jones","doi":"10.1097/01.sa.0000504589.32822.55","DOIUrl":"https://doi.org/10.1097/01.sa.0000504589.32822.55","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75996137","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":"Dose-response of intrathecal morphine when administered with intravenous ketorolac for post-cesarean analgesia: a two-center, prospective, randomized, blinded trial.","authors":"Jeffrey S. Berger, A. González, Amanda N. Hopkins, T. Alshaeri, D. Jeon, S. Wang, Richard L. Amdur, Richard M. Smiley","doi":"10.1097/01.sa.0000515844.54177.fc","DOIUrl":"https://doi.org/10.1097/01.sa.0000515844.54177.fc","url":null,"abstract":"BACKGROUND\u0000The appropriate dose of intrathecal morphine for post-cesarean analgesia is unclear. With the inclusion of routine non-steroidal anti-inflammatory drugs, the required dose of morphine may be significantly less than the 200-300μg common a decade ago. We performed a two-center, prospective, randomized, blinded trial comparing three doses of intrathecal morphine, combined with routine intravenous ketorolac, in 144 healthy women undergoing elective cesarean delivery.\u0000\u0000\u0000METHODS\u0000Patients received an intrathecal injection of hyperbaric bupivacaine 12mg, fentanyl 15μg and a randomized dose of 50, 100, or 150μg morphine in a volume of 2.2mL. Patients received intravenous ketorolac 30mg before leaving the operating room and 15mg intravenously every 6h for the duration of the study (24h). All received postoperative patient-controlled intravenous morphine. The primary endpoint was total intravenous morphine administered postoperatively over 24h, analyzed using mixed model regression.\u0000\u0000\u0000RESULTS\u0000There were no differences between dose groups (or institutions) in intravenous morphine use over 24h. Visual analog scale scores for pain and nausea did not differ. Pruritus was greater in the 100 and 150μg groups than the 50μg group at 6h and 12h, but there was no difference between groups in nausea or pruritus treatments. Respiratory depression or significant sedation did not occur.\u0000\u0000\u0000CONCLUSION\u0000The dose-response relationship of intrathecal morphine for multimodal post-cesarean analgesia suggests that 50μg produces analgesia similar to that produced by either 100μg or 150μg.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75239076","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":"Changes in Therapeutic Hypothermia and Coronary Intervention Provision and In-hospital Mortality of Patients With Out-of-Hospital Cardiac Arrest: A Nationwide Database Study","authors":"T. Tagami, H. Matsui, K. Fushimi, H. Yasunaga","doi":"10.1097/01.sa.0000504588.25198.e1","DOIUrl":"https://doi.org/10.1097/01.sa.0000504588.25198.e1","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87114608","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 Effects of Thermal Softening of Double-Lumen Endobronchial Tubes on Postoperative Sore Throat, Hoarseness, and vocal Cord Injuries: A Prospective, Double-blind Randomized Trial","authors":"Jeong-Hwa Seo, C. Cho, D. Hong, Y. Jeon, J. Bahk","doi":"10.1097/01.sa.0000504597.81966.1b","DOIUrl":"https://doi.org/10.1097/01.sa.0000504597.81966.1b","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72774831","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}