The Open Anesthesiology Journal最新文献

{"title":"Editorial - Perioperative Control of Serum Sodium for Liver Transplantation: Time for a More Aggressive Approach?","authors":"A. Nozari, R. Saidi","doi":"10.2174/1874321801004010020","DOIUrl":"https://doi.org/10.2174/1874321801004010020","url":null,"abstract":"In this issue, Dr. D’Oyley reports a rather provocative approach to the perioperative management of hyponatremia, using data from two patients who underwent orthotopic liver transplantation. The author suggests that the routine administration of intravenous furosemide to induce a supranormal diuresis provides a better intraoperative control of serum sodium levels, which can potentially improve the long-term outcome. Hyponatremia is common in patients with chronic liver disease because of low sodium diets, impaired renal handling of free water, and elevated levels of antidiuretic hormone. It may be exacerbated by aggressive diuretic use and is commonly treated with discontinuation of diuretics combined with free water restriction. Despite the evidence that a major tubular effect of furosemide is to inhibit sodium reabsorption in loops of Henle, it has been shown that the administration of the diuretic may result in a net increase in free water excretion in selected patients [1]. The suggested mechanism for an improved water excretion is through an incomplete osmotic equilibration that is achieved during high rates of flow through collecting ducts. Moreover, furosemide may interfere with proximal tubular reabsorption, resulting in an increased delivery of tubular fluid to diluting sites that are unaffected by the drug, and a net increase in the volume of dilute tubular fluid. Therefore, the proposed approach to administer furosemide during liver transplantation may in selected patients result in better perioperative control of hyponatremia. However, cirrhotic patients who require liver transplantation are severely compromised, and have variable degree of renal impairment, [2] making the response to furesmide very unpredictable. Consequently, routine use of furosemide is currently not advised in these patients because it can lead to a worsening of the hyponatremia or too rapid a correction of","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115467763","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":"Automatic Implantable Cardioverter Defibrillator Management in A Patient with Arrythmogenic Right Ventricular Dysplasia having Prone Thoracic Spine Surgery","authors":"C. Hartmann, T. Alston, T. Romanelli, J. Qu, Jingping Wang","doi":"10.2174/1874321801004010022","DOIUrl":"https://doi.org/10.2174/1874321801004010022","url":null,"abstract":"Arrhythmogenic right ventricular dysplasia is an inherited condition causing right ventricular structural and functional changes that can manifest by ventricular arrhythmia, heart failure, and sudden death. Therapy is not well de- fined but avoidance of sudden death is a major goal in patients with the disease. Many patients at high risk for ventricular arrhythmia have undergone automatic implantable cardioverter defibrillator (ICD) placement. This case report discusses the intraoperative management of an ICD in a 50-year-old female with a history of arrhythmogenic right ventricular dys- plasia who underwent posterior spinal arthrodesis of T7-L1.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116600196","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":"LETTER TO THE EDITOR-Attempted Control of Serum Sodium Concentration During Liver Transplantationin Severely Hyponatraemic Patients","authors":"Debbie A. D’Oyley","doi":"10.2174/1874321801004010013","DOIUrl":"https://doi.org/10.2174/1874321801004010013","url":null,"abstract":"Hyponatraemia (serum sodium <135 mmol/L) is very common in patients with end stage liver disease. Between 1993 and 2005, 32.4% of all liver recipients demonstrated a serum sodium concentration <134 mmol -L (10.5% <130 mmol -L ) across the UK and Ireland [1]. Peri-operative [Na] is an important and reliable indicator of severity of illness as patients demonstrate a higher calculated MELD † (22.3+/9.3). A MELD-Na score which can be as much as 13 points higher has also been proposed [2]. Hyponatraemia is also a good predictor of waiting list mortality, longer surgical times, higher intra-operative transfusion requirements, poor post-operative outcomes and reduced 90 day survival 84% versus 95% [1-4]. Major morbidity includes sepsis and multi-organ failure (64.2%), neurological problems (10-30%) and graft failure (8.6%) [1]. Central pontine myelinolysis (CPM) is the most serious neurological sequela and tends to develop up to the 11 th post-operative day [1, 4-6]. It is caused by the osmotic demyelination of neurons as intraoperative serum sodium concentration and osmolality change rapidly [7,8]. Symptoms include lethargy, seizure, coma, permanent brain damage, brainstem herniation, respiratory arrest and death [4].","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127296686","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":"Enhancement of Cortical GABAergic Function does not Account for the Anticonvulsant Effects of Midazolam, Isoflurane or Etomidate~!2009-11-19~!2010-05-23~!2010-07-29~!","authors":"L. Voss","doi":"10.2174/1874321801004010005","DOIUrl":"https://doi.org/10.2174/1874321801004010005","url":null,"abstract":"Background: Enhancement of cerebrocortical GABAergic inhibition is postulated as the main mechanism by which anesthetics inhibit seizures; however this has not been directly tested under controlled conditions. In this study we utilized the isolated cerebral cortex slice preparation and tested the anticonvulsant properties of three anesthetics with differing specificities for GABAergic activation and with various clinical and experimental anticonvulsant efficacy; midazolam, isoflurane and etomidate. Methods: Two interictal-like models were investigated; low-magnesium artificial cerebrospinal fluid (ACSF) and low dose (230nM) aconitine in low-magnesium ACSF. The former generates interictal-like events by facilitating NMDA activation and is well described in the cortical slice preparation; the latter generates a unique pattern of interictal-like ac- tivity by opening voltage-gated sodium channels. Results: We found that at anesthetic concentrations and above (15� M midazolam, 480� M isoflurane and 4� M etomidate), only isoflurane had an anticonvulsant effect. The isoflurane effect was seen as a reduction in event frequency in both models (56% reduction in low-magnesium and 26% reduction in aconitine, p<0.005 and p<0.05, respectively). Picrotoxin (100� M) was ineffective at blocking the isoflurane anticonvulsant effect (56% reduction in event frequency, p<0.01). Picrotoxin (100� M) and bicuculline (25� M) administered on their own increased event frequency (107% and 75%, respectively, p<0.005), indicating the GABAergic system was functional in the slice preparation. Conclusion: These results call into question the view that enhancement of cortical GABAergic function is the primary mechanism by which anesthetics suppress seizure activity.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126119808","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":"Survey of Elective Laryngeal Mask Airway Use in the Presence of Gastroesophageal Reflux Disease","authors":"Allison J. Lee, K. Candiotti","doi":"10.2174/1874321801004010001","DOIUrl":"https://doi.org/10.2174/1874321801004010001","url":null,"abstract":"Concern exists about the potential risks of pulmonary aspiration with the laryngeal mask airway (LMA) due to its inability to provide a tight seal at the larynx. The safety of LMA use in the presence of gastroesophageal reflux disease (GERD) is unclear, as GERD is presumed to increase the risk of aspiration under anesthesia. VA Anesthesiolo- gists were surveyed regarding their practices in the setting of mild, moderately severe and severe symptoms of GERD. Approximately half responded that they would use a standard LMA in a patient with GERD as long as symptoms are mild. Nineteen percent would not use the LMA in any patient with a history of GERD.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116656170","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 Three Different Epidural Solutions in Cardiac Surgery for Stress Protection","authors":"Olivier Jean-François, Prieto Ignatio, Basile Fadi, H. Thomas","doi":"10.2174/1874321800903010001","DOIUrl":"https://doi.org/10.2174/1874321800903010001","url":null,"abstract":"Background: Different solutions are possible for thoracic epidural analgesia in cardiac surgery. So far, local an- esthetics alone or in combination with either clonidine or opioids have been used. Aims: To determine the stress protection provided by different epidural solutions throughout cardiac surgery. Study Design: A randomized, prospective, double blind study in patients undergoing off-pump coronary artery bypass grafting (OPCAB), randomized in three different groups. Thoracic epidural analgesia was installed more than 1 h before application of heparin at levels of T2 to T4; analgesia was provided by 8 ml of bupivacaine 0.25% 15 min prior to surgery and extubation, and 10 ml/h during and up to 72 h after surgery using one of the following regimens: bupivacaine 0.125% solely, bupivacaine 0.125% with fentanyl 3 � g/mL or bupivacaine 0.125% with clonidine 0.6 � g/mL. Patients were block- randomized for one of the three treatments. Cortisol and glucose values were determined before surgery, at extubation and 1h and 3h after surgery. Pain scores were assessed up to 48 h after surgery. Hemodynamic stability was also recorded in form of heart rate, systolic and diastolic blood pressure. Multi-comparison ANOVA and Chi-square test were used to compare the data, presented as mean (SD) or median (25 th and 75 th percentile), P < 0.05. Study Setting: A cardiac surgery unit at a tertiary university hospital. Participants: Forty-two patients undergoing OPCAB were enrolled. Main Results: All patient data as well hemodynamic stability were not different between the three groups. All patients were successfully extubated in theatre immediately after surgery. Pain control was good and not significantly different be- tween the groups. Mean glucose concentrations ± SD before surgery and (significantly higher) 3h after surgery were 5.4 ± 1.0 mmol l -1 and 8.4 ± 1.6 mmol l -1 for bupivacaine alone, 5.2 ± 0.5 mmol l -1 and 8.5 ± 2.2 mmol l -1 for bupivacaine plus fentanyl and 5.5 ± 1.6 mmol l -1 and 9.5 ± 2.1mmol l -1 for bupivacaine and clonidine, respectively. The mean cortisol val- ues ± SD in the pre-operative period and 3h after surgery were 413 ± 162 nmol l -1 and 562 ± 173 nmol l -1 for bupivacaine alone, 393 ± 107 nmol l -1 and 581 ± 265 nmol l -1 for bupivacaine and fentanyl and 409 ± 159 nmol l -1 and 570 ± 160 nmol l -1 for bupivacaine and clonidine, respectively. There were no significant differences between the groups. Conclusions: We conclude that short-term stress protection with TEA is equally effective with solely bupivacaine, bupivacaine with fentanyl or clonidine.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134332066","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":"An Animal Model for the Study of Lung Protective Therapies During One Lung Ventilation (OLV) in Children","authors":"T. Miller, A. Costarino, Alicia Olivant, Doyle J Lim, T. Shaffer, M. Theroux","doi":"10.2174/1874321800802010058","DOIUrl":"https://doi.org/10.2174/1874321800802010058","url":null,"abstract":"One-lung ventilation (OLV) is the intentional collapse of one lung during surgical procedures in the chest. The objective of this report is to demonstrate that a piglet model of pediatric OLV mimics the clinical sequelae, and thus is valid to study lung protective interventions. Pediatric pigs (n = 7; 21 ± 1 d old; 7.7 ± 0.5 kg) were instrumented and ex- posed to OLV (left lung collapsed) for 3 hrs, followed by 30 min of bilateral lung ventilation (BLV) before sacrifice and tissue harvest. Pulmonary compliance (Cp) and resistance (Rp) were measured half-hourly and plasma samples were drawn hourly for inflammatory cytokine analysis. Cp dropped to 86% and Rp rose to 148% of baseline with OLV, which is consistent with clinical observations given the anatomical differences of the pig thorax. Plasma levels of TNF-� and IL- 6 rose throughout the protocol, consistent with clinical observations. Lung histology showed greater atelectasis in the col- lapsed lungs following 30 min of BLV. The piglet model is valid for the study of OLV-induced lung injury and may be useful for the study of potential therapies to improve outcomes in the pediatric population.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122293541","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":"Postoperative Bilateral Palsy of Terminal Laryngeal and Pharyngeal Branches of the Vagal Nerve","authors":"D. Nauheimer, S. Doering, T. Breinlich, G. Geldner","doi":"10.2174/1874321800802010055","DOIUrl":"https://doi.org/10.2174/1874321800802010055","url":null,"abstract":"We report a rare case of a postoperative bilateral laryngeal and pharyngeal lesion of the extracranial vagal nerve following a routine general anaesthesia in prone position. It documents a possible way of a serious complication de- pending to the positioning of the patient in prone position. Etiological factors and measures to avoid this rare but critical complication are discussed. For the clinical practise it should give an advice to minimize the risk of injuries by malpositioning.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132229673","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":"Clinical Pharmacology of Intravenous Paracetamol in Neonates","authors":"K. Allegaert, M. Velde, G. Naulaers","doi":"10.2174/1874321800802010050","DOIUrl":"https://doi.org/10.2174/1874321800802010050","url":null,"abstract":"Effective analgesia in neonates is still hampered due to the lack of data on pharmacokinetics and -dynamics of analgesics in this specific population. To a certain extent, this is even true for paracetamol. An intravenous formulation might improve prediction of concentration and consequent effect compared to enteral administration. In this review, we summarize the consecutive steps reported in literature to document the pharmacokinetics, metabolism and hepatic toler- ance of intravenous paracetamol in neonates. Based on a single intravenous dose study, pharmacokinetics estimates were calculated and a repeated dose regimen was developed. This dose regimen was subsequently evaluated in a repeated dose study, and paracetamol metabolism was de- scribed during repeated dose administration. Finally, hepatic tolerance in neonates was documented. Based on the available pharmacokinetic estimates, it seems that intravenous paracetamol is an attractive analgesic to be used in neonates, as an alternative or add-on therapy for opioid administration. After the documentation of the pharma- cokinetics of paracetamol in neonates and in the absence of any data on pharmacodynamics of intravenous paracetamol in this population, prospective, well designed and appropriated powered pharmacodynamic studies in neonates are urgently needed.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126174137","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":"Kitz-Wilson Mechanisms of Action of Neostigmine and Penicillin","authors":"T. Alston","doi":"10.2174/1874321800802010046","DOIUrl":"https://doi.org/10.2174/1874321800802010046","url":null,"abstract":"The molecular mechanism of penicillin action is closely analogous to that of neostigmine. Both drugs react co- valently with the active-site serine of their target enzymes. In both cases, the susceptible enzymes self-catalyze their inac- tivation by their respective drugs. Kinetic analysis of cholinesterase by Richard J. Kitz and Irwin B. Wilson helped to es- tablish that concept. Neostigmine and penicillin are kindred examples of mechanism-based enzyme inhibition, a generally important phenomenon in pharmacology and physiology.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116324148","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}