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Anaesthesia

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143 papers 100 to 500 followers Interesting articles in adult anaesthesia from the perspective of a paediatric anaesthetist
By Ignacio Galvez Paediatric Consultant Anaesthetist with an interest in research, teaching, difficult airway and regional anaesthesia
https://read.qxmd.com/read/30649072/systematic-review-and-meta-analysis-sometimes-bigger-is-indeed-better
#1
Thomas R Vetter
Clinicians encounter an ever increasing and frequently overwhelming amount of information, even in a narrow scope or area of interest. Given this enormous amount of scientific information published every year, systematic reviews and meta-analyses have become indispensable methods for the evaluation of medical treatments and the delivery of evidence-based best practice. The present basic statistical tutorial thus focuses on the fundamentals of a systematic review and meta-analysis, against the backdrop of practicing evidence-based medicine...
January 14, 2019: Anesthesia and Analgesia
https://read.qxmd.com/read/28258555/propofol-induction-normalizing-the-dose-in-morbidly-obese-patients
#2
EDITORIAL
John H P Friesen
No abstract text is available yet for this article.
May 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://read.qxmd.com/read/30610849/better-with-ultrasound-subclavian-central-venous-catheter-insertion
#3
REVIEW
Scott J Millington, Manoj M Lalu, Michel Boivin, Seth Koenig
The insertion of a subclavian central venous catheter is generally associated with a high rate of success and a favorable risk profile. The use of ultrasound for procedural guidance has been demonstrated to further increase the rate of success and reduce the risk of specific mechanical complications, especially in patients with difficult surface anatomy. Many individual ultrasound techniques have been described in the literature; this article presents a systematic approach for incorporating these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described...
January 2, 2019: Chest
https://read.qxmd.com/read/29687891/videolaryngoscopy-vs-fibreoptic-bronchoscopy-for-awake-tracheal-intubation-a-systematic-review-and-meta-analysis
#4
REVIEW
M Alhomary, E Ramadan, E Curran, S R Walsh
Awake fibreoptic intubation is often considered the technique of choice when a difficult airway is anticipated. However, videolaryngoscopes are being used more commonly. We searched the current literature and performed a meta-analysis to compare the use of videolaryngoscopy and fibreoptic bronchoscopy for awake tracheal intubation. Our primary outcome was the time needed to intubate the patient's trachea. Secondary outcomes included: failed intubation; the rate of successful intubation at the first attempt; patient-reported satisfaction with the technique; and any complications resulting from intubation...
September 2018: Anaesthesia
https://read.qxmd.com/read/30054079/principles-of-urgent-management-of-acute-airway-obstruction
#5
REVIEW
Erkan Yildirim
Recognizing and acting early on airway compromise reduces morbidity and mortality in patients with airway obstruction. Causes include foreign bodies, toxic/hot fumes, difficult intubation, laryngeal spasm, and tumors. Before definitive control of the airway is possible, provide 100% oxygen with a tightly fitting mask to optimize body oxygen stores. Pulse oximetry is a poor indicator of airway compromise; a decreasing arterial hemoglobin oxygen saturation is a late sign of impending hypoxemia. Basic airway maneuvers improve the patency of an obstructed airway...
August 2018: Thoracic Surgery Clinics
https://read.qxmd.com/read/30283785/airway-management-during-anesthetic-induction-of-secondary-laryngectomy-for-recurrent-laryngeal-cancer-three-cases-of-report-and-analysis
#6
Xuezheng Zhang, Omer Cavus, Ying Zhou, Sasima Dusitkasem
Surgery for laryngeal cancer and the following recurrent tumor growth may further change the anatomy of the airway. Airway management during anesthesia induction is challenging for the patients undergoing secondary surgery due to recurrence of laryngeal cancer or its postoperative complication, but it has never been reported. In this report, we described three cases of anesthetic induction which had different process of airway events. The first case was given intravenous general anesthetic for induction and experienced failed intubation, difficult mask ventilation and emergent tracheostomy, eventually were rescued successfully...
2018: Frontiers in Medicine
https://read.qxmd.com/read/30291405/-management-of-the-difficult-airway-overview-of-the-current-guidelines
#7
REVIEW
J C Schäuble, T Heidegger
Several national airway task forces have recently updated their recommendations for the management of the difficult airway in adults. Routinely responding to airway difficulties with an algorithm-based strategy is consistently supported. The focus is increasingly not on tools and devices but more on good planning, preparation and communication. In the case of anticipated airway difficulties the airway should be secured when the patient is awake with maintenance of spontaneous ventilation. Unaltered a flexible bronchoscopic intubation technique is advised as a standard of care in such patients...
October 2018: Der Anaesthesist
https://read.qxmd.com/read/29935584/nociceptive-activation-in-spinal-cord-and-brain-persists-during-deep-general-anaesthesia
#8
G Lichtner, R Auksztulewicz, H Velten, D Mavrodis, M Scheel, F Blankenburg, F von Dincklage
BACKGROUND: In clinical practice, analgesic drug doses applied during general anaesthesia are considered sufficient when clinical responses (e.g. movement, blood pressure and heart rate elevations) are suppressed during noxious stimulation. We investigated whether absent clinical responses are indicative of suppressed spinal and brain responsiveness to noxious stimulation in anaesthetised subjects. METHODS: Ten healthy volunteers were investigated during deep propofol anaesthesia supplemented with increasing doses of remifentanil in a stepwise manner...
July 2018: British Journal of Anaesthesia
https://read.qxmd.com/read/30500064/pre-operative-fasting-in-adults-and-children-clinical-practice-and-guidelines
#9
REVIEW
W J Fawcett, M Thomas
It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be detrimental. Although advised fasting times for solids remain unchanged, there is good evidence to support a 1-h fast for children, with no increase in risk of pulmonary aspiration. In adults, a major focus has been the introduction of carbohydrate loading before anaesthesia, so that patients arrive for surgery not only hydrated but also in a more normal metabolic state...
November 30, 2018: Anaesthesia
https://read.qxmd.com/read/30277931/lung-protective-ventilation-in-the-operating-room-individualized-positive-end-expiratory-pressure-is-needed
#10
Robert M Kacmarek, Jesús Villar
No abstract text is available yet for this article.
December 2018: Anesthesiology
https://read.qxmd.com/read/29704223/low-thoracic-erector-spinae-plane-block-for-perioperative-analgesia-in-lumbosacral-spine-surgery-a-case-series
#11
Josh P Melvin, Rudolph J Schrot, George M Chu, Ki Jinn Chin
PURPOSE: Severe postoperative pain following spine surgery is a significant cause of morbidity, extended length of facility stay, and marked opioid usage. The erector spinae plane (ESP) block anesthetizes the dorsal rami of spinal nerves that innervate the paraspinal muscles and bony vertebra. We describe the use of low thoracic ESP blocks as part of multimodal analgesia in lumbosacral spine surgery. CLINICAL FEATURES: We performed bilateral ESP blocks at the T10 or T12 level in six cases of lumbosacral spine surgery: three lumbar decompressions, two sacral laminoplasties, and one coccygectomy...
September 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://read.qxmd.com/read/29471884/should-we-measure-the-central-venous-pressure-to-guide-fluid-management-ten-answers-to-10-questions
#12
Daniel De Backer, Jean-Louis Vincent
The central venous pressure (CVP) is the most frequently used variable to guide fluid resuscitation in critically ill patients, although its use has been challenged. In this viewpoint, we use a question and answer format to highlight the potential advantages and limitations of using CVP measurements to guide fluid resuscitation.
February 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/29313905/renal-complications-of-anaesthesia
#13
REVIEW
J McKinlay, E Tyson, L G Forni
Peri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury...
January 2018: Anaesthesia
https://read.qxmd.com/read/29280475/the-comparative-efficacy-and-safety-of-sugammadex-and-neostigmine-in-reversing-neuromuscular-blockade-in-adults-a-cochrane-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#14
REVIEW
A-M Hristovska, P Duch, M Allingstrup, A Afshari
We compared the efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. Our outcomes were: recovery time from second twitch to train-of-four ratio > 0.9; recovery time from post-tetanic count 1-5 to train-of-four ratio > 0.9; and risk of composite adverse and serious adverse events. We searched for randomised clinical trials irrespective of publication status and date, blinding status, outcomes reported or language. We included 41 studies with 4206 participants...
May 2018: Anaesthesia
https://read.qxmd.com/read/29206696/the-perioperative-significance-of-systemic-arterial-diastolic-hypertension-in-adults
#15
REVIEW
Daniel I Asher, Edwin G Avery
PURPOSE OF REVIEW: Hypertension affects approximately one third of the U.S. population and is the most common preventable medical reason that surgical cases are postponed or cancelled. However, subtypes of hypertension and their perioperative risks are poorly studied and understood. We will review the natural history and pathophysiology of essential hypertension and discuss the perioperative significance of diastolic blood pressure elevation. RECENT FINDINGS: There is evidence that elevated preoperative diastolic blood pressures are associated with an increased perioperative risk of cardiovascular and cerebrovascular events and increased postoperatively 30-day mortality...
February 2018: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/29206697/perioperative-pulmonary-thromboembolism-current-concepts-and-treatment-options
#16
REVIEW
David M Ruohoniemi, Akhilesh K Sista, Charles F Doany, Paul M Heerdt
PURPOSE OF REVIEW: Anesthesiologists are familiar with pulmonary emboli prophylaxis paradigms and many have witnessed acute intraoperative embolization. Clinicians must balance conservative anticoagulation and aggressive intervention in perioperative submassive pulmonary emboli, yet the bulk of the literature excludes surgery as a relative contraindication. This review will summarize the current treatment options for acute pulmonary emboli, drawing attention to special considerations in perioperative submassive pulmonary emboli, and discuss right ventricular monitoring to improve assessment of intervention efficacy...
February 2018: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/29227289/perioperative-steroid-therapy-where-s-the-evidence
#17
REVIEW
Leon Freudzon
PURPOSE OF REVIEW: Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. RECENT FINDINGS: Evidence suggests low incidence of perioperative adrenal insufficiency in patients receiving chronic glucocorticoid therapy. Recent studies show no difference in survival or hemodynamic sequella by withholding perioperative stress steroids; however, these studies are limited in size and universal applicability...
February 2018: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/29206698/surgery-and-discontinuation-of-angiotensin-converting-enzyme-inhibitors-current-perspectives
#18
REVIEW
Nikola Bradic, Zdenko Povsic-Cevra
PURPOSE OF REVIEW: The current article reviews the current evidence for continuing or discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) during the perioperative period. RECENT FINDINGS: In patients undergoing treatment of hypertension with ACEIs or ARBs, there are both benefits associated with continuing these medications during the perioperative period and higher risk for perioperative hypotension and its complications...
February 2018: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/29227290/postoperative-thrombocytopenia-why-you-should-consider-antiplatelet-therapy
#19
REVIEW
Andres O Raso Vasquez, Miklos D Kertai, Manuel L Fontes
PURPOSE OF REVIEW: This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long-term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. RECENT FINDINGS: Our recent findings suggest that in some patients, the hemostatic balance during and after surgery may shift toward a hypercoagulable state and contribute to acute organ failure...
February 2018: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/29164530/ultrasound-guided-lateral-medial-transmuscular-quadratus-lumborum-block-for-analgesia-following-anterior-iliac-crest-bone-graft-harvesting-a-clinical-and-anatomical-study
#20
Rakesh V Sondekoppam, Vivian Ip, David F Johnston, Vishal Uppal, Marjorie Johnson, Sugantha Ganapathy, Ban C H Tsui
BACKGROUND: The anterior iliac crest (AIC) is one of the most common sites for harvesting autologous bone, but the associated postoperative pain can result in significant morbidity. Recently, the transmuscular quadratus lumborum block (TQL) has been described to anesthetize the thoraco-lumbar nerves. This study utilizes a combination of cadaveric models and clinical case studies to evaluate the dermatomal coverage and analgesic utility of TQL for AIC bone graft donor site analgesia. METHODS: Ten ultrasound-guided TQL injections were performed in five cadaver specimens using a lateral-to-medial transmuscular approach...
February 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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