IMPLICATIONS: These Guidelines, published by the American Heart Association/American College of Cardiology, discuss the available literature on perioperative beta blockade for noncardiac surgery and define recommendations with the strength of evidence. By identifying Class I recommendations, the Guidelines may have implications with relation to pay-forperformance or pay-for-reporting activities. The AHA/ACC agree that patient care is our highest priority, and all decisions must be made by the provider and the patient, taking into consideration all circumstances presented by the particular patient.
IMPLICATIONS: Our findings suggest that perioperative {beta}-blockers reduce cardiac arrhythmias and myocardial ischemia. In contrast to previous belief, the literature does not provide evidence for a protective effect of perioperative {beta}-blockers against myocardial infarction or overall mortality.
IMPLICATIONS: Recent metformin ingestion does not increase the risk of mortality after cardiac surgery. Metformin treatment is associated with decreased risk for pulmonary and infection morbidity after cardiac surgery.
IMPLICATIONS: A prospective, randomized and blinded study of 200 coronary artery bypass patients, in whom cerebral oxygen saturation was actively monitored and maintained, demonstrated significantly fewer incidences of major organ morbidity and mortality in comparison with that in patients in an unmonitored control group.
IMPLICATIONS: This randomized, controlled study demonstrates that electrocardiogram guidance results in more accurate positioning of central venous catheters. Use of this technique reduces the need for repositioning postoperatively and could potentially improve patient safety.
IMPLICATIONS: We report a case of successful cardiac resynchronization therapy in the early postoperative period after cardiac surgery in a patient with electrical and mechanical left ventricular dyssynchrony. Maxime Cannesson, Bruno Gostoli, Pascal Rosamel, Claire Flamens, Genevieve Derumeaux, Philippe Chevallier, Jean-Francois Obadia, Olivier Bastien, and Jean-Jacques Lehot
IMPLICATIONS: During propofol anesthesia, children aged 3-11 yr require a remifentanil infusion rate almost twofold higher than adults to block the somatic response to skin incision.
IMPLICATIONS: This case report highlights the effect of pulmonary artery pressure reduction when the patent ductus arteriosus is ligated in an infant with an anomalous coronary artery.
IMPLICATIONS: Premedication with transdermal scopolamine (TDS) was as effective as droperidol (1.25 mg) or ondansetron (4 mg) in preventing nausea and vomiting in the early and late postoperative periods. However, the use of a TDS patch is more likely to produce a dry mouth.
IMPLICATIONS: Premedication with oral gabapentin, 1.2 g, decreased tourniquet pain, intraoperative fentanyl and postoperative diclofenac use in patients receiving IV regional anesthesia for hand surgery. Gabapentin also improved the quality of surgical anesthesia.
IMPLICATIONS: We found that the Cobra Perilaryngeal Airway (CobraPLA) and the Laryngeal Mask Airway-Classic have similar insertion characteristics. However, the CobraPLA had a higher incidence of blood on the device after removal. Both devices provide adequate ventilation during gynecological laparoscopy, but the CobraPLA maintains airway seal at higher peak airway pressures.
IMPLICATIONS: We investigated the effect of IV Xenon (Xe)-containing normal saline and a Xe-containing lipid formulation on spinal dorsal horn neurons in vivo. Xe revealed preventive, but no antinociceptive action in spinal pain pathways. Xe equilibrated in Lipofundin MCT(R) 20% showed no additional effects when compared with the solvent alone, which blocked the induction of long-term potentiation.
IMPLICATIONS: We studied the pulmonary vascular effect of propofol in isolated perfused rat lungs. During {alpha}-adrenoreceptor activation, propofol may increase pulmonary vascular resistance by partially inhibiting the cyclooxygenase pathway in normal rats and by partially activating the protein kinase C pathway in monocrotaline-induced pulmonary hypertensive rats.
IMPLICATIONS: Millimolar concentrations of lidocaine, but not bupivacaine, increase cleaved caspase 3 expression in the rat hippocampal slice. This may provide a working hypothesis to account for the preferential neurotoxic effects of lidocaine reported after spinal anesthesia.
IMPLICATIONS: Landiolol, injected at low doses of 0.1 or 0.2 mg/kg 4 min before endotracheal intubation, prevents intubation-induced tachycardia with no obvious untoward effects on arterial blood pressure in normotensive and hypertensive patients.
IMPLICATIONS: The AnaConDa(R) filter permits administration of volatile anesthetic without the use of an anesthesia machine. This study shows that the device is generally reliable, but that there are several conditions in which it might deliver more anesthetic than intended.
IMPLICATIONS: An electroencephalogram (EEG) player was designed which allows playback of stored EEG data. Hence, EEG recordings can be used to evaluate different monitors of the hypnotic component of anesthesia or reproducibility of their output.
IMPLICATIONS: A data-driven process improvement project for noncardiac surgery antibiotic prophylaxis administration was undertaken using Six Sigma methodology and was enhanced through the use of an electronic anesthesia record keeping system.
IMPLICATIONS: The closed claims database was reviewed for pediatric anesthesia cases. Not only respiratory, but also cardiovascular events were major sources of liability in the 1990's.
IMPLICATIONS: Anesthesiologists attempted to detect faults during anesthesia machine checkout. Participants with more than 7 yr of practice since training detected less than half.
IMPLICATIONS: In severely hypovolemic hypotensive pigs, use of a new noninvasive device, the intrathoracic pressure regulator (ITRP) increased survival rates. When treating intraoperative hypotension and traumatic injury, the ITPR rapidly increases arterial blood pressure and may reduce the need for immediate intravascular fluid resuscitation and drug therapy until more definitive care is available.
IMPLICATIONS: We report a patient who, after implantation of a spinal cord stimulator, manifested locked-in syndrome resulting from a conversion disorder. Before considering a psychological cause, all organic factors should be excluded with proper tests and consultations, as conversion disorder is a diagnosis of exclusion.
IMPLICATIONS: Postural orthostatic tachycardia syndrome is a neurovascular disorder that is related to the presence of tachycardia, with symptoms of orthostatic intolerance, when patients are in the upright position. We report the anesthetic management of a parturient who underwent successful labor and vaginal delivery with epidural anesthesia.
IMPLICATIONS: IV lidocaine given after endotracheal intubation attenuates bronchoconstriction in asthmatic patients.
IMPLICATIONS: The two selective IV nonpeptide agonists at the opioid receptor-like receptor 1 (ORL1) demonstrate hypnotic and antinociceptive effects in mice and rats. The ORL1 receptor is an appropriate target for novel anesthetic development.
IMPLICATIONS: The antiepileptic drug levetiracetam blunted the decrease in nociceptive reflex threshold after pentobarbital and midazolam administration, suggesting that levetiracetam may be useful in preventing the excitability induced by small concentrations of anesthetics.
IMPLICATIONS: Lipid infusion in l-bupivacaine-induced cardiac depression had a significant positive inotropic effect. Lipids did not reverse all l-bupivacaine effects. Decreased l-bupivacaine concentrations due to binding of l-bupivacaine to lipids in the perfusate cannot be excluded.
IMPLICATIONS: In patients undergoing major abdominal surgery, the transversus abdominus plane block provided high-quality analgesia for the first 24 postoperative hours.
IMPLICATIONS: Severe pain can be associated with chemical pleurodesis, prompting physicians to choose thoracoscopic talc poudrage under general rather than local anesthesia. We describe a novel spray catheter technique with lidocaine to enhance pleural anesthesia before talc poudrage in five patients with severe chronic obstructive pulmonary disease.
IMPLICATIONS: Spinal cord dysfunction may be the result of surgical procedures rather than an epidural hematoma or local anesthetics. Immediate investigation is critical to allow intervention for reversible etiologies.
IMPLICATIONS: Ischemia of the conus medullaris was the cause of postoperative sensory-motor symptoms of the lower limbs appearing after pulmonary lobectomy in a patient who received thoracic epidural analgesia.
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