MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Best Practice and Research. Clinical Anaesthesiology' source. Fri, 19 Mar 2010 13:45:11 +0100 http://www.medworm.com/index.php?rid=3323642&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS152168961000011X%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323642 Mon, 01 Mar 2010 00:00:00 +0100 3323642 http://www.medworm.com/index.php?rid=3323641&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000767%2Fabstract%3Frss%3Dyes One of the greatest disappointments associated with a successful surgical procedure is a thrombotic or thrombo-embolic complication in the postoperative period. Morbidity and mortality of the perioperative period are related, to a relevant degree, to perioperative thrombo-embolic events. Ranging from simple deep venous thrombosis to pulmonary embolism or arterial thrombosis, this class of complication invariably increases length of hospital stay or may result in mortality. The purpose of this review is to identify the procedures and patient populations noted to have thrombophilia in the postoperative period, link the changes in circulating and in situ haematological/biochemical substrates most likely responsible for morbidity, identify the clinical diagnostic modalities that detect recent/... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323641 Mon, 01 Mar 2010 00:00:00 +0100 3323641 http://www.medworm.com/index.php?rid=3323640&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000688%2Fabstract%3Frss%3Dyes This article presents an overview of current guidelines on the use of regional anaesthetic techniques in patients treated with various anticoagulants and also describes a possible strategy to deal with new antithrombotic drugs that have recently been introduced in some countries or will be shortly in others. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323640 Mon, 01 Mar 2010 00:00:00 +0100 3323640 http://www.medworm.com/index.php?rid=3323639&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000780%2Fabstract%3Frss%3Dyes This article provides an overview of the scientific evidence regarding the efficacy and safety of antifibrinolytic agents and desmopressin to reduce surgical blood loss. The synthetic derivatives of lysine are the only antifibrinolytics available in clinical practice since the withdrawal of aprotinin. There is evidence that the prophylactic use of lysine analogues is efficacious in reducing perioperative blood loss in cardiac and major orthopaedic surgery. The impact on exposure to blood transfusion is, however, variable. There is no evidence at present that they improve the overall outcome. Lysine analogues appear to be well tolerated in coronary artery bypass surgery, but less is known regarding their risk–benefit profile in special patient groups. Further studies are needed to elucida... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323639 Mon, 01 Mar 2010 00:00:00 +0100 3323639 http://www.medworm.com/index.php?rid=3323638&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS152168960900069X%2Fabstract%3Frss%3Dyes Recombinant activated factor VII (rFVIIa) is a haemostatic agent, which was originally developed for the treatment of haemophilia patients with inhibitors against factor FVIII or FIX. The efficacy of rFVIIa in preventing or stopping life-threatening bleeding for these patients has been demonstrated in several studies. Since the first report about the successful use of rFVIIa in a bleeding soldier in 1999, rFVIIa has gained popularity as an adjunct for the treatment of coagulopathy in a wide array of clinical conditions with serious or life-threatening bleeding. The number of case reports and case series documenting the successful use of rFVIIa as last resort to terminate uncontrollable bleeding has steadily grown.Conflicting results have been reported from various studies. Considering the ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323638 Mon, 01 Mar 2010 00:00:00 +0100 3323638 http://www.medworm.com/index.php?rid=3323637&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000755%2Fabstract%3Frss%3Dyes Unexplained intra-operative coagulopathies continue to be a diagnostic and therapeutic dilemma. The pathophysiology behind unexplained intra-operative coagulopathies is of great variety and complexity (pre-existing coagulopathies, dilutional coagulopathy, interactions of medications, etc.). We have shown in prospective studies that patients undergoing elective surgery who develop ’unexplained' intra-operative bleeding have significantly less F. XIII per unit thrombin available at any point in time (i.e., also already preoperatively) than patients without such coagulopathies. The consequence is a significant loss of clot firmness associated with an increase in intra-operative blood loss. Thus, these patients have less cross-linking capacity to begin with, which explains their preoperative... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323637 Mon, 01 Mar 2010 00:00:00 +0100 3323637 http://www.medworm.com/index.php?rid=3323636&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000937%2Fabstract%3Frss%3Dyes Platelets are active metabolising cells that are evolved for the tasks of haemostasis, inflammatory reactions and wound healing. When platelet products are stored in the blood bank a complex series of changes occur, leading to partial activation, up-regulation of inflammatory mediators, cellular morphology changes, loss of cell membrane lipids and micro-particle formation, as well as apoptosis. The resultant coagulation transfusion product has a number of potential expected side effects including fever, alloimmunisation, sepsis, thrombosis and transfusion-related acute lung injury. Of course, these events are occasional side effects yet they are some of the most common potential disasters of transfusion. Platelet transfusions in patients bleeding from thrombocytopaenia or severe platelet s... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323636 Mon, 01 Mar 2010 00:00:00 +0100 3323636 http://www.medworm.com/index.php?rid=3323635&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000718%2Fabstract%3Frss%3Dyes Clinical studies support the use of perioperative fresh frozen plasma (FFP) in patients who are actively bleeding with multiple coagulation factor deficiencies and for the prevention of dilutional coagulopathy in patients with major trauma and/or massive haemorrhage. In these settings, current FFP dosing recommendations may be inadequate. However, a substantial proportion of FFP is transfused in non-bleeding patients with mild elevations in coagulation screening tests. This practice is not supported by the literature, is unlikely to be of benefit and unnecessarily exposes patients to the risks of FFP. The role of FFP in reversing the effects of warfarin anticoagulation is dependent on the clinical context and availability of alternative agents. Although FFP is commonly transfused in patien... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323635 Mon, 01 Mar 2010 00:00:00 +0100 3323635 http://www.medworm.com/index.php?rid=3323634&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS152168960900072X%2Fabstract%3Frss%3Dyes Interruption or maintenance of anti-platelet agents (APAs) during surgical or invasive procedures is associated with an increase in cardiovascular or haemorrhagic complications, respectively. The pharmacology and indications of aspirin, clopidogrel and prasugrel are summarised. The utility and risks of interruption, the optimal delay between stent implantation and surgery, the appropriate window of preoperative interruption, the potential usefulness of bridging, the safest delay between the end of surgery and resumption of APA are detailed in this review. Some non- evidence-based suggestions are given to help the physicians in their daily clinical practice. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323634 Mon, 01 Mar 2010 00:00:00 +0100 3323634 http://www.medworm.com/index.php?rid=3323633&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000731%2Fabstract%3Frss%3Dyes is the rational diagnostic basis for pro- and anti-thrombotic interventions in patients undergoing emergency and elective surgery. The main goal of perioperative monitoring of haemostasis is to increase safety of patients undergoing surgical procedures.Currently, there is a change in paradigm with (1) increasing implementation of evidence-based approach to preoperative patient evaluation with laboratory coagulation testing secondary to the results of the standardised bleeding history and (2) awareness of the limitations of routine coagulation tests to guide coagulation management in massive bleeding. Alternatively, visco-elastic point-of-care monitoring is increasingly used worldwide. This innovative methodology triggers a trend towards an ‘early goal-directed coagulation management’ ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323633 Mon, 01 Mar 2010 00:00:00 +0100 3323633 http://www.medworm.com/index.php?rid=3323632&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000743%2Fabstract%3Frss%3Dyes Abnormal coagulation parameters can be found in 25% of trauma patients with major injuries. Furthermore, trauma patients presenting with coagulopathy on admission have worse clinical outcome. Tissue trauma and systemic hypoperfusion appear to be the primary factors responsible for the development of acute traumatic coagulopathy immediately after injury. As a result of overt activation of the protein C pathway, the acute traumatic coagulopathy is characterised by coagulopathy in conjunction with hyperfibrinolysis. This coagulopathy can then be exacerbated by subsequent physiologic and physical derangements such as consumption of coagulation factors, haemodilution, hypothermia, acidemia and inflammation, all factors being associated with ongoing haemorrhage and inadequate resuscitation or tr... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323632 Mon, 01 Mar 2010 00:00:00 +0100 3323632 http://www.medworm.com/index.php?rid=3323631&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000706%2Fabstract%3Frss%3Dyes Perioperative coagulopathy impacts on patient outcome by influencing final blood loss and transfusion requirements. The recognition of pre-existing disturbances and the basic understanding of the principles of and dynamic changes of haemostasis during surgery are pre-conditions for safe patient management. The newly developed cellular model of coagulation facilitates the understanding of coagulation, thereby underscoring the importance of the tissue factor-bearing cell and the activated platelet. Amount of blood loss as well as amount and type of fluids used are the main factors involved in the development of dilutional coagulopathy, which is the most frequently observed cause of coagulopathy in the otherwise healthy surgical patient. Recent data from studies using viscoelastic coagulation... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323631 Mon, 01 Mar 2010 00:00:00 +0100 3323631 http://www.medworm.com/index.php?rid=3323630&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000925%2Fabstract%3Frss%3Dyes In the past years, there has been a renewed interest in haemostasis and its management in the perioperative period. The clotting cascade has been replaced by a cell-based representation of coagulation and there has been a thorough interest to understand not only a single part but the overall picture of the coagulation system in the perioperative period with its pro-coagulant as well as anti-coagulant and fibrinolytic control mechanisms. Furthermore, a new respect for the endothelium as an active driver of these processes has been established recently. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323630 Mon, 01 Mar 2010 00:00:00 +0100 3323630 http://www.medworm.com/index.php?rid=3323629&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689610000078%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3323629 Mon, 01 Mar 2010 00:00:00 +0100 3323629 http://www.medworm.com/index.php?rid=3053659&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000895%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053659 Tue, 01 Dec 2009 00:00:00 +0100 3053659 http://www.medworm.com/index.php?rid=3053658&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000512%2Fabstract%3Frss%3Dyes This article presents a template for judging trials of tight glucose control in critically ill patients. It reviews threats to both internal validity and generalisability using examples from the current literature. When judging internal validity, it is important to consider factors specific to trials of glucose control (particularly the methods of glucose control, measurement and reporting) in addition to factors common to all randomised controlled trials (such as treatment allocation, losses to follow-up and protocol violations). Judging generalisability requires the identification of differences between the trial population and the population for whom the intervention is being considered. These may relate to the setting, the patients or the practical delivery of tight glucose control or ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053658 Tue, 01 Dec 2009 00:00:00 +0100 3053658 http://www.medworm.com/index.php?rid=3053657&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000664%2Fabstract%3Frss%3Dyes Tight glycaemic control (TGC) for patients treated in an intensive care unit ICU is associated with an increased risk for hypoglycaemia. Since hypoglycaemia mainly occurs in the sickest patients, no matter whether TGC is applied or not, it might be a marker for severity of illness or a harmful event in itself. Furthermore, it remains a matter of debate whether harmful effects of hypoglycaemia outbalance the clinical benefits of TGC. This review focusses on the clinical manifestations of hypoglycaemia in the critically ill and highlights its potential short- and long-term consequences specifically concerning neurocognitive function. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053657 Tue, 01 Dec 2009 00:00:00 +0100 3053657 http://www.medworm.com/index.php?rid=3053656&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000652%2Fabstract%3Frss%3Dyes This article offers the clinical anesthesiologist direction for the organisation of inpatient blood glucose control in acute situations, in the perioperative setting and in the intensive care unit. An effective, safe and user-friendly algorithm for intravenous insulin administration is presented that can be executed by regular nurses and used in many situations. Practical advice is offered for the use of subcutaneous basal–bolus insulin, for fasting orders and for transition to discharge care. The main safety considerations are discussed. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053656 Tue, 01 Dec 2009 00:00:00 +0100 3053656 http://www.medworm.com/index.php?rid=3053655&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000524%2Fabstract%3Frss%3Dyes High blood glucose levels have been associated with morbidity and poor outcome in critically ill patients, irrespective of underlying pathology. In a large, randomised, controlled study the use of insulin therapy to maintain normoglycaemia for at least a few days improved survival and reduced morbidity of patients who are in a surgical intensive care unit (ICU). Since the publication of this landmark study, several other investigators have provided support for, whereas others have questioned, the beneficial effects of intensive insulin therapy.In this review, we discuss the investigated potential molecular mechanisms behind the clinical benefits of intensive insulin therapy. We first describe the molecular origin of hyperglycaemia and the impact of the therapy on insulin sensitivity. Next,... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053655 Tue, 01 Dec 2009 00:00:00 +0100 3053655 http://www.medworm.com/index.php?rid=3053654&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000469%2Fabstract%3Frss%3Dyes Hyperglycaemia and glucose variability occur frequently during critical illness or after major surgery in children and are associated with worse outcome. Association does not necessarily imply causality however, and the question whether tight glycaemic control (TGC) with insulin infusion improves morbidity and mortality can only be answered by randomised controlled trials (RCTs). Currently, only one single-centre RCT exists, proving the concept of TGC in critically ill children. Attenuation of inflammation and reduction of secondary infections, decreased prolonged stay in intensive care and reduced dependency on haemodynamic support were accomplished, despite a substantial increased incidence of biochemical hypoglycaemia. Before universal implementation in paediatric intensive care both lo... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053654 Tue, 01 Dec 2009 00:00:00 +0100 3053654 http://www.medworm.com/index.php?rid=3053653&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000470%2Fabstract%3Frss%3Dyes Acute kidney injury is a frequent and life-threatening complication of critical illness. Prevention of this condition is crucial. Two randomized single center trials in critically ill patients have shown a decrease in acute kidney injury by tight glycaemic control, an effect that appears most pronounced in surgical patients. Subsequent randomized trials did not confirm this renoprotective effect. This apparent contradiction is likely explained by methodological differences between studies, including different patient populations, insufficient patient numbers, comparison with a different control group, use of inaccurate blood glucose analyzers, and differences in the degree of reaching the target blood glucose level. The optimal glycaemic target for renoprotection in critical illness remain... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053653 Tue, 01 Dec 2009 00:00:00 +0100 3053653 http://www.medworm.com/index.php?rid=3053652&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000482%2Fabstract%3Frss%3Dyes While stress hyperglycaemia has traditionally been regarded as an adaptive, beneficial response, it is clear that hyperglycaemia and hypoglycaemia are associated with increased risk of death in critically ill intensive care unit (ICU) patients. Recent studies on blood-glucose control failed to fully clarify whether this association is causal. Early proof-of-concept single-centre randomised controlled studies found that maintaining normoglycaemia by intensive insulin therapy, as compared with tolerating hyperglycaemia as an adaptive response, improved patient outcome. However, recent large multicentre studies VISEP, GLUCONTROL and NICE-SUGAR) could not confirm this survival benefit.Methodological disparity in the execution of the complex intervention of tight glycaemic control may have cont... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053652 Tue, 01 Dec 2009 00:00:00 +0100 3053652 http://www.medworm.com/index.php?rid=3053651&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000792%2Fabstract%3Frss%3Dyes The benefits of tight glycaemic control (TGC) were first shown in cardiac surgical patients with diabetes. These concepts migrated to other surgical and medical specialties through intensive care units caring for a variety of patients with a variety of disease states. Although some disagreement and controversy surrounds the use of TGC in the medical population, the benefits of this therapy in the diabetes cardiac surgery population is unblemished. Perioperative hyperglycaemia has been shown to be associated with adverse surgical outcomes in several different patient populations. TGC for 3 full postoperative days or more mitigates these risks. Although this has been definitively proven in the diabetes coronary artery bypass graft (CABG) population, evidence for beneficial effects of TGC in... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053651 Tue, 01 Dec 2009 00:00:00 +0100 3053651 http://www.medworm.com/index.php?rid=3053650&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000494%2Fabstract%3Frss%3Dyes This article summarises the present understanding of the mechanisms behind the positive clinical effects and gives an overview of the information available regarding the clinical effects of this treatment. Finally, the article summarises the most recently published national guidelines on preoperative fasting routines where preoperative carbohydrates are recommended for use before a major surgery. These are to be considered for all patients allowed to drink clear fluids and undergoing elective surgery. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053650 Tue, 01 Dec 2009 00:00:00 +0100 3053650 http://www.medworm.com/index.php?rid=3053649&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000676%2Fabstract%3Frss%3Dyes Hyperglycaemia is commonly found in critically ill patients as a result of numerous processes such as increased gluconeogenesis and glycogenolysis caused by elevated levels of corresponding hormones and insulin resistance. As the clinical consequence of hyperglycaemia has been shown to increase morbidity and mortality in various clinical settings, many hospitals by now use tight glycaemic control protocols for their patients in intensive care units to maintain normoglycaemia. The success of the intensive insulin therapy depends crucially on frequent and accurate blood glucose measurements with immediate feedback of results. Therefore, in almost all cases, this will be done by point-of-care testing methods, raising the question of how accurately blood glucose levels are actually measured an... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053649 Tue, 01 Dec 2009 00:00:00 +0100 3053649 http://www.medworm.com/index.php?rid=3053648&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000500%2Fabstract%3Frss%3Dyes Stress hyperglycaemia is a distinctive clinical feature of critical illness. Stress mediators, namely stress hormones, cytokines and the central nervous system, interfere with normal carbohydrate metabolism, especially in the liver and skeletal muscle. Central insulin resistance, defined as increased hepatic gluconeogenesis and glucose output despite abundant endogenous insulin levels, appears pivotal to the occurrence of stress hyperglycaemia. The skeletal muscle is refractory to insulin action too. Peripheral insulin resistance is predominantly attributed to inhibition of the skeletal muscle glycogen synthesis. Significantly increased non-insulin-mediated glucose transport into the skeletal muscle overrules defective insulin-mediated glucose transport.Inflammatory mediators and counter-r... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053648 Tue, 01 Dec 2009 00:00:00 +0100 3053648 http://www.medworm.com/index.php?rid=3053647&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000779%2Fabstract%3Frss%3Dyes This issue of Best Practice and Research-Clinical Anesthesiology is dedicated to tight glycaemic control during the perioperative and critically ill phase of patients being admitted to intensive care units. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053647 Tue, 01 Dec 2009 00:00:00 +0100 3053647 http://www.medworm.com/index.php?rid=3053646&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000858%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=3053646 Tue, 01 Dec 2009 00:00:00 +0100 3053646 http://www.medworm.com/index.php?rid=2783276&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000627%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783276 Mon, 31 Aug 2009 23:00:00 +0100 2783276 http://www.medworm.com/index.php?rid=2783275&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000457%2Fabstract%3Frss%3Dyes This article covers current provision of training in echocardiography and ultrasound in areas relevant to anaesthetists who are working in critical care (including accident and emergency) and complex surgery (mainly cardiac). (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783275 Mon, 31 Aug 2009 23:00:00 +0100 2783275 http://www.medworm.com/index.php?rid=2783274&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000263%2Fabstract%3Frss%3Dyes Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. Assessment of the basic haemodynamic state is a very important part of ultrasound use in trauma, but is discussed in more detail elsewhere. Focussed assessment with sonography for Trauma (FAST) rapidly assesses for haemoperitoneum and haemopericardium, and the Extended FAST examination (EFAST) explores for haemothorax, pneumothorax and intravascular filling status. ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783274 Mon, 31 Aug 2009 23:00:00 +0100 2783274 http://www.medworm.com/index.php?rid=2783273&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000196%2Fabstract%3Frss%3Dyes The dislodgement of atheroma from the ascending aorta and proximal arch is a major cause of stroke and neurological injury following cardiac surgery. The accurate detection of atheroma prior to aortic manipulation is necessary to facilitate surgical strategies to reduce the risk of embolisation.The traditional method for atheroma detection is manual palpation by the surgeon. This technique misses about half the number of the atheroma lesions, as the soft (non-calcified) lesions offer little resistance to the surgeon's fingers. Trans-oesophageal echocardiography (TOE) is commonly used in cardiac surgery, but the interposition of the bronchus between the aorta and the oesophagus causes an ultrasound ‘blind spot’ in the ascending aorta and proximal arch, such that it does not offer improv... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783273 Mon, 31 Aug 2009 23:00:00 +0100 2783273 http://www.medworm.com/index.php?rid=2783272&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000275%2Fabstract%3Frss%3Dyes Major surgery is associated with significant trauma and is a potential cause of multiple system organ failure and death. Measurement of cardiac output using a variety of techniques during the perioperative period has enabled practitioners to proactively optimise stroke volume and cardiac output in an attempt to reduce postoperative complications. Although pulmonary artery catheter has been widely used and considered as the gold standard for measuring cardiac output, recent advancement of technology has seen the development of a number of less-invasive haemodynamic monitors. Oesophageal Doppler ultrasonography is a minimally invasive method for measuring stroke volume and cardiac output. It is user-friendly and is one of the few low-invasive technologies to date, which has been used success... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783272 Mon, 31 Aug 2009 23:00:00 +0100 2783272 http://www.medworm.com/index.php?rid=2783271&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000202%2Fabstract%3Frss%3Dyes This article focusses on the recent growing evidence to support the benefits of its use in nerve and plexus blocks. Common complications of nerve blocks can be avoided with ultrasound but have still been reported. Anatomical variants have been demonstrated by ultrasound and it has proved to be useful in performing regional anaesthesia in difficult situations or where peripheral nerve stimulation is unsuccessful or inappropriate. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783271 Mon, 31 Aug 2009 23:00:00 +0100 2783271 http://www.medworm.com/index.php?rid=2783270&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000214%2Fabstract%3Frss%3Dyes This article summarises the literature on complication rates, efficacy and safety of ultrasound-guided vascular access procedures and describes a practical method of ultrasound-guided central venous access and arterial catheterisation. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783270 Mon, 31 Aug 2009 23:00:00 +0100 2783270 http://www.medworm.com/index.php?rid=2783269&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000238%2Fabstract%3Frss%3Dyes The use of echocardiography in anaesthesia and critical care started with transoesophageal echocardiography, whereas transthoracic echocardiography was largely the domain of the cardiologist. In recent times, there has been a change in focus towards transthoracic echocardiography owing to the development of small and portable, yet high-fidelity, echocardiography machines. The cost has reduced, thereby increasing the availability of equipment. A parallel development has been the concept of limited transthoracic echocardiography that can be performed by practitioners with limited experience. The basis of these examinations is to provide the practising clinician with immediate information to help guide management with a focus on haemodynamic evaluation, and limited structural (valve) assessme... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783269 Mon, 31 Aug 2009 23:00:00 +0100 2783269 http://www.medworm.com/index.php?rid=2783268&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000226%2Fabstract%3Frss%3Dyes The haemodynamic state refers to the integration of myocardial and vascular systems, and involves both left and right hearts, and systolic and diastolic phases. The assessment of the haemodynamic state can be performed with echocardiography, and provides a higher level of diagnosis than conventional pressure- and flow-based monitoring. Whilst hypotension alerts the practitioner about the existence of haemodynamic abnormality, it does not provide sufficient information to identify the cause or the underlying haemodynamic state. The premise of haemodynamic state monitoring is that better diagnosis will lead to more rational therapy, which in turn may improve the outcome.The haemodynamic state can be classified into seven broad categories: normal, empty, vasodilation, systolic failure, primar... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783268 Mon, 31 Aug 2009 23:00:00 +0100 2783268 http://www.medworm.com/index.php?rid=2783267&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS152168960900024X%2Fabstract%3Frss%3Dyes Trans-oesophageal echocardiography (TOE) has profoundly changed cardiac surgery and the role of the cardiac anaesthesiologist. It has been the driving force for a real-time diagnostic and decision-making partnership between cardiac anaesthesiologists and cardiac surgeons that has significantly advanced the safety and effectiveness of modern cardiac surgery. With the information provided by TOE, anaesthesiologists and surgeons may redirect the care of cardiac surgical patients to decrease morbidity and mortality. As a result, routine intra-operative TOE is an expectation in many cardiac surgical practices. While some colleagues continue to question whether TOE should be used routinely in all cardiac surgical patients, we believe that it is impossible to predict in which cardiac patients TOE... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783267 Mon, 31 Aug 2009 23:00:00 +0100 2783267 http://www.medworm.com/index.php?rid=2783266&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000251%2Fabstract%3Frss%3Dyes Echography has developed as an indispensable tool in diagnosis and subsequent therapy in the critically ill. Although pulmonary and abdominal ultrasounds play a major role in their management, this article will discuss the advantages and indications of echocardiography in the intensive care unit (ICU). The assessment of morphological abnormalities, left or right ventricular malfunction, pulmonary arterial hypertension and valvular dysfunctions is a routine indication of echocardiography. Actually, besides contractility, several preload and even afterload indicators can also be assessed. In short, this bedside tool rapidly provides insight in the haemodynamics without invasive pressure estimations. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783266 Mon, 31 Aug 2009 23:00:00 +0100 2783266 http://www.medworm.com/index.php?rid=2783265&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000044%2Fabstract%3Frss%3Dyes This article gives the anaesthesiolgoist an overview about the relevant indications for ultrasound in non-cardiac surgical patients. Other chapters will focus in more detail on different aspects of ultrasound use in non-cardiac anaesthesia.Echocardiography is a monitoring tool for cardiac structures and function. In the anaesthetized patient the transoesophageal approach is preferred due to the unrestricted ultrasound view to the heart. Its use for non-cardiac surgery is discussed.The use of transcutaneous ultrasound in anaesthesia is mainly interventional: The puncture rate for vascular access e.g. central venous catheterization is higher and the procedure can be performed safer under continuous sonographic guidance.Nerve blockade under direct visualisation of target and accompanying stru... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783265 Mon, 31 Aug 2009 23:00:00 +0100 2783265 http://www.medworm.com/index.php?rid=2783264&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000445%2Fabstract%3Frss%3Dyes When I first learnt echocardiography in 1995, it was with the cardiologists and therefore predominantly transthoracic echocardiography. As a cardiac anaesthetist, I had to use transoesophageal echocardiography, and furthermore, it had to be at an advanced or diagnostic level. This was hampered by few standards and even fewer educational materials. It was terribly controversial, with many practitioners more concerned about the risk of oesophageal rupture, rather than the potential benefit that echocardiography could provide to patients undergoing cardiac surgery. In cardiac anaesthesia, the uptake of TOE was very rapid, becoming a standard of care in many institutions world wide. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783264 Mon, 31 Aug 2009 23:00:00 +0100 2783264 http://www.medworm.com/index.php?rid=2783263&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000585%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2783263 Mon, 31 Aug 2009 23:00:00 +0100 2783263 http://www.medworm.com/index.php?rid=2470156&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000391%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470156 Mon, 01 Jun 2009 04:00:00 +0100 2470156 http://www.medworm.com/index.php?rid=2470155&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000992%2Fabstract%3Frss%3Dyes Haemostatic alterations associated with the use of fluids are related to non-specific dilutional effects and colloid-specific effects, such as acquired von Willebrand syndrome, inhibition of platelet function and fibrin polymerization. Judging by currently available evidence, dextran, hetastarch and pentastarch have a more pronounced impact than tetrastarch, gelatin and albumin. In patients with hypocoagulability, tetrastarch appears to be a suitable volume expander due to its high safety index and volume efficacy. Gelatins have lower inhibitory effects on clot strength compared with tetrastarch, but their volume efficacy is also lower. Dextrans are potent anticoagulants with a high risk for adverse reactions. Albumin has negligible effects on haemostasis, but low volume efficacy and costs... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470155 Mon, 01 Jun 2009 04:00:00 +0100 2470155 http://www.medworm.com/index.php?rid=2470154&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608001006%2Fabstract%3Frss%3Dyes Peri-operative fluid therapy continues to be an exercise in empiricism, with nagging questions about efficacy and complications. Pharmacokinetics is used for studying the time dependency of administered drugs. Volume kinetics is a pharmacokinetic approach describing the peak effects and clearance of intravenously infused fluids. It clarifies the absorption, distribution, metabolism and excretion of an intravenous fluid bolus. This could possibly allow for more rational design of intravenous fluid paradigms to improve clinical fluid therapy. This chapter briefly summarizes currently accepted principles of fluid therapy, discusses the general approach to kinetic analysis of fluid therapy, reviews currently available data defining kinetic responses to fluid therapy, and speculates about futur... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470154 Mon, 01 Jun 2009 04:00:00 +0100 2470154 http://www.medworm.com/index.php?rid=2470153&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000980%2Fabstract%3Frss%3Dyes Current guidelines on initial haemodynamic stabilization in shock states suggest infusion of either natural or artificial colloids or crystalloids. However, as the volume of distribution is much larger for crystalloids than for colloids, resuscitation with crystalloids alone requires more fluid and results in more oedema, and may thus be inferior to combination therapy with colloids. This chapter describes the currently available synthetic colloid solutions [i.e. dextran, gelatin and hydroxyethyl starch (HES)] in detail, and critically discusses their specific effects including potential adverse effects. Literature was selected from medical databases (including Medline and the Cochrane library), as well as references extracted from the available publications. Dextrans appear to have the mo... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470153 Mon, 01 Jun 2009 04:00:00 +0100 2470153 http://www.medworm.com/index.php?rid=2470152&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608001018%2Fabstract%3Frss%3Dyes The relevance of albumin administration in the critical care setting remains controversial. We know that albumin has numerous important physiological effects and many potentially beneficial effects in critical illness. We also know that hypoalbuminaemia is common in critically ill patients and is associated with worse outcomes. And we know that routine administration of albumin for fluid resuscitation is not warranted. Albumin may be useful in some patients, especially those with hypoalbuminaemia at risk of complications or those with liver insufficiency. Further studies are needed to clarify what precise role albumin has in today's ICU. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470152 Mon, 01 Jun 2009 04:00:00 +0100 2470152 http://www.medworm.com/index.php?rid=2470151&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608001031%2Fabstract%3Frss%3Dyes Disorders of fluid and electrolyte balance in the critically ill are volume-related, compositional, or both. Targeting ‘normal’ values for plasma volume, osmolality and electrolytes might not be optimal in conditions as diverse as intracranial trauma/haemorrhage, hepatic encephalopathy, abdominal hypertension, or major surgery, because a hyperosmolar state seems to favourably affect tissue (brain and intestinal) oedema formation. However, adequately powered studies regarding the impact of hypertonic saline on outcome are lacking. Isotonic crystalloids are the cornerstone of resuscitation and must be balanced against natural or artificial colloids and vasopressors. Crystalloid resuscitation is superior to vasopressors in shock associated with blunt trauma, and is at least not inferior t... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470151 Mon, 01 Jun 2009 04:00:00 +0100 2470151 http://www.medworm.com/index.php?rid=2470150&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS152168960800102X%2Fabstract%3Frss%3Dyes Hypovolaemia is a common cause of circulatory failure in the perioperative period. However, only 50% of critically ill patients respond to volume expansion with an adequate increase in cardiac output. Therefore, in daily clinical practice it is still a challenge to assess each subject's individual position on the Starling curve in order to optimize cardiac preload and avoid deleterious fluid overload. Recently, systolic pressure variation, stroke volume variation, and pulse pressure variation have been introduced as dynamic variables of fluid responsiveness which reflect ventilation-induced cyclic changes in left ventricular stroke volume. The concept of fluid responsiveness has been recognized for more than 20 years, and several studies have shown the superiority of these dynamic variable... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470150 Mon, 01 Jun 2009 04:00:00 +0100 2470150 http://www.medworm.com/index.php?rid=2470149&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000299%2Fabstract%3Frss%3Dyes For decades, the ‘third space’ was looked upon as an actively consuming compartment. Therefore, perioperative fluid regimens were traditionally based on a generous replacement of this assumed primary loss, in addition to deficits due to insensible perspiration and fasting. The practical consequence was an extremely positive fluid balance in order to maintain blood volume during major surgery. Whereas the insensible perspiration and the preoperative deficits are in fact often negligible, and the third space appears to be only a fictional construct, the excess fluid most likely accumulates interstitially. Such shifting is related to a destruction of the endothelial glycocalyx, a key structure of the vascular barrier, by traumatic inflammation and iatrogenic hypervolaemia. This explains w... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470149 Mon, 01 Jun 2009 04:00:00 +0100 2470149 http://www.medworm.com/index.php?rid=2470148&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000287%2Fabstract%3Frss%3Dyes Topics related to fluid management are among the most controversially and intensively discussed ones in both research and daily clinical practice. In this issue of Best Practice & Research Clinical Anaesthesiology entitled ‘VOLUME REPLACEMENT IN ANAESTHESIA AND INTENSIVE CARE’, hot topics in this field are thoroughly outlined by internationally recognised experts in this field. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470148 Mon, 01 Jun 2009 04:00:00 +0100 2470148 http://www.medworm.com/index.php?rid=2470147&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000354%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2470147 Mon, 01 Jun 2009 04:00:00 +0100 2470147 http://www.medworm.com/index.php?rid=2342580&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000147%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342580 Sun, 01 Mar 2009 05:00:00 +0100 2342580 http://www.medworm.com/index.php?rid=2342579&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000839%2Fabstract%3Frss%3Dyes Computerization in healthcare in general, and in the operating room (OR) and intensive care unit (ICU) in particular, is on the rise. This leads to large patient databases, with specific properties. Machine learning techniques are able to examine and to extract knowledge from large databases in an automatic way. Although the number of potential applications for these techniques in medicine is large, few medical doctors are familiar with their methodology, advantages and pitfalls. A general overview of machine learning techniques, with a more detailed discussion of some of these algorithms, is presented in this review. (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342579 Sun, 01 Mar 2009 05:00:00 +0100 2342579 http://www.medworm.com/index.php?rid=2342578&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000020%2Fabstract%3Frss%3Dyes Telemedicine has been studied in the intensive care unit for several decades, but many questions remain unanswered regarding the costs and the benefits of its application. Telemedicine ICU (Tele-ICU) is an electronic means to link physical ICUs to another location which assists in medical decision making. Given the shortage of intensive care physicians in the US, Tele-ICU systems could be an efficient mechanism for physicians to manage a larger number of critical care patients. This chapter will examine the current state of telemedicine in an age of rapidly expanding medical information technology and increasing demand for intensive care services. While we believe that the future of Tele-ICU is promising, there are multiple issues that must be addressed to increase the benefit of Tele-ICU.... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342578 Sun, 01 Mar 2009 05:00:00 +0100 2342578 http://www.medworm.com/index.php?rid=2342577&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000633%2Fabstract%3Frss%3Dyes The potential clinical applications of active control for pharmacology in general, and anesthesia and critical care unit medicine in particular, are clearly apparent. Specifically, monitoring and controlling the depth of anesthesia in surgery and the intensive care unit is of particular importance. Nonnegative and compartmental models provide a broad framework for biological and physiological systems, including clinical pharmacology, and are well suited for developing models for closed-loop control for drug administration. These models are derived from mass and energy balance considerations that involve dynamic states whose values are nonnegative and are characterized by conservation laws (e.g., mass, energy, fluid, etc.) capturing the exchange of material between kinetically homogenous en... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342577 Sun, 01 Mar 2009 05:00:00 +0100 2342577 http://www.medworm.com/index.php?rid=2342576&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000815%2Fabstract%3Frss%3Dyes New modes of mechanical ventilation with advanced closed loops are now available, and in the future these could assume a greater role in supporting critically ill patients in intensive care units (ICUs) for several reasons. Two modes of ventilation – proportional assist ventilation and neurally adjusted ventilatory assist – deliver assisted ventilation proportional to the patient's effort, improving patient–ventilator synchrony. Also, a few systems that automate the medical reasoning with advanced closed-loops, such as SmartCare and adaptive support ventilation, have the potential to improve knowledge transfer by continuously implementing automated protocols. Moreover, they may improve patient–ventilator interactions and outcomes, and provide a partial solution to the forecast clin... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342576 Sun, 01 Mar 2009 05:00:00 +0100 2342576 http://www.medworm.com/index.php?rid=2342575&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000591%2Fabstract%3Frss%3Dyes Blood glucose control performed by intensive care unit (ICU) nurses is becoming standard practice for critically ill patients. New algorithms, ranging from basic protocols to elementary computerized protocols to advanced computerized protocols, have been presented during the last years aiming to reduce the workload of the medical team. This paper gives an overview of the different types of algorithms and their features. Performance comparisons between different algorithms are avoided as blood glucose sampling frequencies and protocol durations were not similar among different studies and even within studies. Particularly advanced computerized protocols can potentially be introduced as fully-automated blood glucose algorithms when accurate and reliable near-continuous glucose sensor devices... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342575 Sun, 01 Mar 2009 05:00:00 +0100 2342575 http://www.medworm.com/index.php?rid=2342574&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000840%2Fabstract%3Frss%3Dyes Variation in clinical practice impedes control, is associated with unwanted and widespread error, and may preclude replicability. Methodologic replicability enhances our ability to detect signals of interest by both increasing the signal through consistent application of the intervention, and by reducing the obscuring effects of noise. Decision-support tools are intended to standardize some aspect of clinical care and thereby help lead to uniform implementation of clinical interventions. This is realized by explicit replicable computer protocols that can produce appropriate patient-specific decisions and introduce control of process into clinical care. Development of such protocols has required around-the-clock implementation for patient management because of the influence of patient histo... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342574 Sun, 01 Mar 2009 05:00:00 +0100 2342574 http://www.medworm.com/index.php?rid=2342573&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000645%2Fabstract%3Frss%3Dyes Alarms in medical devices are a matter of concern in critical and perioperative care. The high rate of false alarms is not only a nuisance for patients and caregivers, but can also compromise patient safety and effectiveness of care. The development of alarm systems has lagged behind the technological advances of medical devices over the last 20 years. From a clinical perspective, major improvements in alarm algorithms are urgently needed. This review gives an overview of the current clinical situation and the underlying problems, and discusses different methods from statistics and computational science and their potential for clinical application. Some examples of the application of new alarm algorithms to clinical data are presented. (Source: Best Practice and Research. Clinical Anaesthe... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342573 Sun, 01 Mar 2009 05:00:00 +0100 2342573 http://www.medworm.com/index.php?rid=2342572&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS152168960800058X%2Fabstract%3Frss%3Dyes Computerized physician order entry means prescribing of medication and ordering laboratory tests or radiology examinations in an electronic way instead of using paper forms. In itself, it offers advantages such as legible orders, faster order completion, inventory management and automatic billing. If combined with clinical decision support, the real benefits of CPOE become apparent in the first place by prevention of medication errors and adverse drug events. On the contrary, if CPOE configuration is not done carefully, adverse drug events can be facilitated. Therefore, and for reasons of end-user acceptance, implementation is challenging. CPOE has the potential for significant economic saving. However, the initial implementation cost is high. (Source: Best Practice and Research. Clinical ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342572 Sun, 01 Mar 2009 05:00:00 +0100 2342572 http://www.medworm.com/index.php?rid=2342571&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000852%2Fabstract%3Frss%3Dyes The number of operating rooms and intensive care departments equipped with a clinical information system (CIS) is rapidly expanding. Amongst the putative advantages of such an installation, reduction in workload for the clinician is one of the most appealing. The scarce studies looking at workload variations associated with the implementation of a CIS, only focus on direct workload discarding indirect changes in workload. Descriptions of the various methods to quantify workload are provided.The hypothesis that a third generation CIS can reduce documentation time for ICU nurses and increase time they spend on patient care, is supported by recent literature. Though it seems obvious to extrapolate these advantages of a CIS to the anesthesiology department or physicians in the intensive care, ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342571 Sun, 01 Mar 2009 05:00:00 +0100 2342571 http://www.medworm.com/index.php?rid=2342570&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689608000608%2Fabstract%3Frss%3Dyes The number of operating rooms and intensive care units looking for a data management system to perform their increasingly complex tasks is rising. Although at this time only a minority is computerized, within the next few years many centres will start implementing information technology. The transition towards a computerized system is a major venture, which will have a major impact on workflow. This chapter reviews the present literature. Published papers on this subject are predominantly single- or multi-centre implementation reports. The general principles that should guide such a process are described. For healthcare institutions or individual practitioners that plan to undertake this venture, the implementation process is described in a practical, nine-step overview. (Source: Best Prac... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342570 Sun, 01 Mar 2009 05:00:00 +0100 2342570 http://www.medworm.com/index.php?rid=2342569&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS1521689609000032%2Fabstract%3Frss%3Dyes The tasks of a clinician in the operating room (OR) or the intensive care unit (ICU) have become increasingly complex: not only because medical knowledge grows exponentially every year, but also because the regulatory and administrative burden on clinicians is rising. The clinical information systems (CIS) that are currently on the market are capable of supporting the clinical and organisational management of our ICUs and ORs. Currently only a minority of them are computerized. This way, healthcare is decades behind other businesses such as industry, aviation or banking. Apart from the CIS, information technology (IT) is entering our working environment through our monitors, mechanical ventilators and infusion pumps which become more sophisticated with each generation of these devices. Thi... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342569 Sun, 01 Mar 2009 05:00:00 +0100 2342569 http://www.medworm.com/index.php?rid=2342568&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.clinicalanaesthesiology.com%2Farticle%2FPIIS152168960900010X%2Fabstract%3Frss%3Dyes (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2342568 Sun, 01 Mar 2009 05:00:00 +0100 2342568 http://www.medworm.com/index.php?rid=2105127&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137806%26dopt%3DAbstract Authors: Kurz A PMID: 19137806 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105127 Mon, 01 Dec 2008 05:00:00 +0100 2105127 http://www.medworm.com/index.php?rid=2105126&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137807%26dopt%3DAbstract Authors: Kurz A Core body temperature is one of the most tightly regulated parameters of human physiology. At any given time, body temperature differs from the expected value by no more than a few tenths of a degree. However, slight daily variations are due to circadian rhythm, and, in women, monthly variations are due to their menstrual cycle. Importantly, both anesthesia and surgery dramatically alter this delicate control, and as a result intraoperative core temperatures 1 to 3 degrees C below normal are not uncommon. Consequently, perioperative hypothermia leads to a number of complications including postoperative shivering (which unacceptably increases patients' metabolic rates), impaired coagulation, prolonged drug action, and negative postoperative nitrogen balance. In this revi... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105126 Mon, 01 Dec 2008 05:00:00 +0100 2105126 http://www.medworm.com/index.php?rid=2105125&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137808%26dopt%3DAbstract Authors: Reynolds L, Beckmann J, Kurz A Perioperative hypothermia is a common and serious complication of anesthesia and surgery and is associated with many adverse perioperative outcomes. It prolongs the duration of action of inhaled and intravenous anesthetics as well as the duration of action of neuromuscular drugs. Mild core hypothermia increases thermal discomfort, and is associated with delayed post anaesthetic recovery. Mild hypothermia significantly increases perioperative blood loss and augments allogeneic transfusion requirement. Only 1.9 degrees C core hypothermia triples the incidence of surgical wound infection following colon resection and increases the duration of hospitalization by 20%. Hypothermia adversely affects antibody- and cell-mediated immune defences, as well a... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105125 Mon, 01 Dec 2008 05:00:00 +0100 2105125 http://www.medworm.com/index.php?rid=2105124&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137809%26dopt%3DAbstract Authors: Torossian A Incidence of inadvertent perioperative hypothermia is still high, and thus thermoregulatory standards are warranted. This review summarizes current evidence of thermal management during anaesthesia, referring to recognized clinical queries (temperature measurement, definition of hypothermia, risk factors, warming methods, implementation strategies). Body temperature is a vital sign, and 37 degrees C is the mean core temperature of a healthy human. Systematic review shows that for non-invasive temperature monitoring the oral route is the most reliable; infrared ear temperature measurement is inaccurate. Intraoperatively, acceptable semi-invasive temperature monitoring sites are the nasopharynx, oesophagus and urinary bladder. Clinically relevant hypothermia starts a... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105124 Mon, 01 Dec 2008 05:00:00 +0100 2105124 http://www.medworm.com/index.php?rid=2105123&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137810%26dopt%3DAbstract This article is designed to give an overview on the various causes of hyperthermia with special emphasis on fever during general and regional anaesthesia in general and neurological critical care patients. PMID: 19137810 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105123 Mon, 01 Dec 2008 05:00:00 +0100 2105123 http://www.medworm.com/index.php?rid=2105122&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137811%26dopt%3DAbstract Authors: Campos JM, Paniagua P This chapter describes the incidence, mechanisms and possible consequences of hypothermia during cardiac surgery, including protection against ischaemia, alteration of the coagulation cascade and the inflammatory response. Various temperature-specific topics related to cardiac surgery are discussed, including the use of hypothermia or normothermia during cardiopulmonary bypass, and the temperature reached during rewarming at the end of cardiopulmonary bypass and its deleterious consequences for the brain (postoperative neurocognitive dysfunction). Various locations for monitoring body temperature and their correlation with the central core temperature are evaluated, as is the correlation between oxygenation of the brain and oxygen extraction monitored at ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105122 Mon, 01 Dec 2008 05:00:00 +0100 2105122 http://www.medworm.com/index.php?rid=2105121&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137812%26dopt%3DAbstract Authors: Holzer M, Behringer W About 17 million people worldwide die from cardiovascular diseases each year. Impaired neurologic function after sudden cardiac arrest is a major cause of death in these patients. Up to now, no specific post-arrest therapy was available to improve outcome. Recently, two randomized clinical trials of mild therapeutic hypothermia after successful resuscitation from cardiac arrest showed improvement of neurological outcome and reduced mortality. A broad implementation of this new therapy could save thousands of lives worldwide, as only 6 patients have to be treated to get one additional patient with favourable neurological recovery. At present, myocardial reperfusion by thrombolytic therapy or primary PCI as early as possible is the most effective therapy in... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105121 Mon, 01 Dec 2008 05:00:00 +0100 2105121 http://www.medworm.com/index.php?rid=2105120&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19137813%26dopt%3DAbstract Authors: Kimberger O, Kurz A In recent years the use of mild therapeutic hypothermia as a means of neuroprotection has become an important concept for treatment after cerebral ischemic hypoxic injury. Mild therapeutic hypothermia has been shown to improve outcome after out-of-hospital cardiac arrest, and many studies suggest a beneficial effect of mild therapeutic hypothermia on patient outcome after traumatic brain injury, cerebrovascular damage and neonatal asphyxia. This review article explores the numerous possibilities and methods for the induction of mild therapeutic hypothermia, reviews thermoregulatory management during maintenance and discusses associated risks and complications. PMID: 19137813 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesio... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=2105120 Mon, 01 Dec 2008 05:00:00 +0100 2105120 http://www.medworm.com/index.php?rid=1851615&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831294%26dopt%3DAbstract Authors: Nemergut EC PMID: 18831294 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851615 Mon, 01 Sep 2008 04:00:00 +0100 1851615 http://www.medworm.com/index.php?rid=1851614&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831295%26dopt%3DAbstract Authors: Zingg W, Cartier-Fässler V, Walder B Most patients in the hospital need vascular access: a peripheral venous line, a short-term non-cuffed central venous catheter (CVC), a long-term cuffed CVC, an implantable port or an arterial line. Such devices, although often indispensable and of benefit, may have the disadvantage of mechanical complications, local exit-site infections or catheter-associated bloodstream infections (CRBSI). Apart from peripheral venous lines, non-cuffed CVCs are the most frequent catheter type in hospitals. The risk for CRBSI of such catheters is high with an incidence density of 2 to 7 episodes per 1000 catheter-days depending on ward-type, institution and geographical region. This review describes the epidemiology, the frequency and the risk of CRBSI... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851614 Mon, 01 Sep 2008 04:00:00 +0100 1851614 http://www.medworm.com/index.php?rid=1851613&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831296%26dopt%3DAbstract Authors: Mauermann WJ, Sampathkumar P, Thompson RL Deep sternal wound infections (DSWI) continue to be a relatively uncommon event occurring in about 1%-2% of all patients undergoing cardiac surgery. However, the sheer number of cardiac surgery patients and the relatively high mortality associated with DSWIs makes them of clinical relevance. This review will describe the current incidence of DSWIs and their associated morbidity and mortality as well as risk factors for the development of this complication. The microbiology of DSWIs will be reviewed and strategies to prevent these complications will be discussed with a focus on interventions that may be undertaken by the clinical anesthesiologist. PMID: 18831296 [PubMed - in process] (Source: Best Practice and Research. Clinical Ana... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851613 Mon, 01 Sep 2008 04:00:00 +0100 1851613 http://www.medworm.com/index.php?rid=1851612&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831297%26dopt%3DAbstract Authors: Wiener-Kronish JP, Dorr HI The diagnosis of ventilator-associated pneumonia, VAP, is problematic because of a lack of objective tools that are utilized to make an assessment of bacterial-induced lung injury in a heterogeneous group of hosts. Clinical symptoms and signs are used to identify patients that may have a "lung infection". However, the symptoms and signs can be produced by a myriad of other conditions. Recent clinical data also suggests bacterial-induced pathologic processes occur prior to the onset of the symptoms and signs. Utilizing bacterial culture alone, health care practitioners are forced to wait for days for results and will have to order days of empiric antibiotic therapy. Exploratory molecular studies utilizing clone libraries and molecular arrays for micro... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851612 Mon, 01 Sep 2008 04:00:00 +0100 1851612 http://www.medworm.com/index.php?rid=1851611&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831298%26dopt%3DAbstract Authors: Horlocker TT, Wedel DJ Although individual cases have been reported in the literature, serious infections of the central nervous system (CNS) such as arachnoiditis, meningitis, and abscess following spinal or epidural anesthesia are rare. However, recent epidemiologic series from Europe suggest that the frequency of infectious complications associated with neuraxial techniques may be increasing. Importantly, while meningitis and epidural abscess are both complications of neuraxial block, the risk factors and causative organisms are disparate. For example, staphylococcus is the organism most commonly associated epidural abscess; often these infections occurred in patients with impaired immunity. Conversely, meningitis follows dural puncture, and is typically caused by alpha-hem... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851611 Mon, 01 Sep 2008 04:00:00 +0100 1851611 http://www.medworm.com/index.php?rid=1851610&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831299%26dopt%3DAbstract Authors: Dichtwald S, Weinbroum AA The use of non-conventional agents aimed at causing panic and terror among civilians has a long history. There have been uninterrupted threats and the use of biological and chemical weaponry from the time of early tribal conflicts to the Iran-Iraq war. The sole practical experience has come from the release of the nerve gas Sarin in a Tokyo subway (1994) and the inhalational anthrax discovered in Florida (2001). Drills that simulate scenarios of biological/chemical mass infestation have yielded valuable theoretical experience. This chapter reviews the main chemical and biological agents possibly obtainable by individuals and groups, and the anaesthesiologist's tasks during the resultant non-conventional multi-casualty scenarios. It briefly illustrates... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851610 Mon, 01 Sep 2008 04:00:00 +0100 1851610 http://www.medworm.com/index.php?rid=1851609&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831300%26dopt%3DAbstract Authors: Buddeberg F, Schimmer BB, Spahn DR The risk of acquiring a transfusion-transmitted infection has declined in recent years. However, after human immunodeficiency virus and hepatitis B and C virus transmission were successfully reduced, new pathogens are threatening the safety of the blood supply, especially in the face of rising numbers of immunocompromised transfusion recipients. Despite new standards in the manufacture and storage of blood products, bacterial contamination still remains a considerable cause of transfusion-related morbidity and mortality. Better allograft survival in kidney transplant patients and higher cancer recurrence rate in surgical oncology patients after allogeneic blood transfusions highlighted a previously underestimated side-effect: transfusion-rela... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851609 Mon, 01 Sep 2008 04:00:00 +0100 1851609 http://www.medworm.com/index.php?rid=1851608&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831301%26dopt%3DAbstract Authors: Shilling AM, Raphael J Postoperative infection is not only a major source of morbidity and mortality in patients undergoing surgery, but also an important cause of increased hospital stay and resource utilization. Diabetes has been shown in multiple studies to increase the risk of post-surgical infection. More recently, hyperglycemia has been investigated as an independent risk factor for postoperative infection. This paper will review the effects of intra-operative, postoperative, and long-term glycemic control on postoperative infection rates. The mechanisms by which surgery causes hyperglycemia will be reviewed, as well as the immunologic and humeral effects of hyperglycemia. PMID: 18831301 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiol... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851608 Mon, 01 Sep 2008 04:00:00 +0100 1851608 http://www.medworm.com/index.php?rid=1851607&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831302%26dopt%3DAbstract Authors: Thiele RH, Huffmyer JL, Nemergut EC The patient's external environment plays a significant, and in some cases dominant, role in his or her infection risk. The use of ultraclean air for certain procedures, as well as avoidance of hypothermia have been proven to reduce the risk of infection. There is no data to support the routine use of surgical masks (by surgeons or staff), ventilating helmets, or routine cleaning of all environmental surfaces in between cases. More research needs to be done in order to determine whether OR design changes, in addition to increasing OR efficiency and thus reducing case times, can also reduce infection rates. Further research is also needed to determine whether or not double gloves and/or the use of antiseptic scrubbing in addition to painting a... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851607 Mon, 01 Sep 2008 04:00:00 +0100 1851607 http://www.medworm.com/index.php?rid=1851606&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831303%26dopt%3DAbstract This article will review the basic science underlying these observations, along with the clinical data that support the use of hyperoxia in preventing and treating infections. PMID: 18831303 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851606 Mon, 01 Sep 2008 04:00:00 +0100 1851606 http://www.medworm.com/index.php?rid=1851605&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831304%26dopt%3DAbstract Authors: James M, Martinez EA Surgical site infections remain a significant contributor to postoperative morbidity and mortality. It is estimated that 500,000 patients suffer from this complication annually. Among other interventions, appropriate administration of prophylactic antibiotics has been shown to decrease the risk of perioperative infections. The goal of prophylactic antibiotic administration is to decrease the risk of contamination of the wound from skin flora in the case of clean procedures, and to add coverage of organisms that are anticipated to contaminate the surgical field, as in open bowel procedures. The purpose of this review is to summarize the guiding principles of perioperative antibiotic administration including selection, timing, redosing, and discontinuation. ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851605 Mon, 01 Sep 2008 04:00:00 +0100 1851605 http://www.medworm.com/index.php?rid=1851604&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831305%26dopt%3DAbstract Authors: Littlewood KE The perioperative management of immunosuppressed patients remains relatively unsophisticated. Rational management involves understanding the normal immune response to injury as modified by the preexisting or imposed abnormalities that immunosuppressed patients manifest on the basis of their disease and/or treatment. Patients with cancer, infected with human immunodeficiency virus, and having had an organ transplant are extreme examples of disordered immunity and it is important to understand the effects of their diseases and treatments. In the future, however, more appropriate management will require anticipation and appreciation of frequent preoperative immunotherapy, a more complete understanding of the immunological response to anesthesia and surgery, the abil... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851604 Mon, 01 Sep 2008 04:00:00 +0100 1851604 http://www.medworm.com/index.php?rid=1851603&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18831306%26dopt%3DAbstract Authors: Castro BA Surgical procedures routinely challenge the pediatric host defense mechanisms. In normal situations the innate and adaptive immune mechanisms are prepared for this challenge. However, in many circumstances these mechanisms are compromised. In neonates, particularly premature infants, the immune system is not fully developed. The etiology of the immunocompromised state in pediatric patients may be primary (SCID, hypogammaglobulinemia) or secondary (cystic fibrosis, sickle cell disease). Knowledge of the basic elements of the immune system and how these elements are altered in the immunocompromised patient will help guide peri-operative management. PMID: 18831306 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1851603 Mon, 01 Sep 2008 04:00:00 +0100 1851603 http://www.medworm.com/index.php?rid=1689546&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683470%26dopt%3DAbstract Authors: Westphal M, Ertmer C PMID: 18683470 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689546 Sun, 01 Jun 2008 04:00:00 +0100 1689546 http://www.medworm.com/index.php?rid=1689545&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683471%26dopt%3DAbstract Authors: Vincent JL, Su F Arginine vasopressin, a hypothalamic peptide hormone, has multiple physiological functions, including body water regulation, control of blood pressure and effects on body temperature, insulin release, corticotropin release, memory and social behaviour. These functions are achieved via at least three specific G-protein-coupled vasopressin receptors. Development of specific vasopressin receptor antagonists in recent years is helping to elucidate the precise actions of vasopressin at each of these receptor types. The complex signalling and messenger processes which take place after receptor stimulation are now more clearly understood. Vasopressin dysregulation can occur in various disease processes, and a better understanding of the mechanisms underlying physiolo... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689545 Sun, 01 Jun 2008 04:00:00 +0100 1689545 http://www.medworm.com/index.php?rid=1689544&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683472%26dopt%3DAbstract Authors: Maybauer MO, Maybauer DM, Enkhbaatar P, Traber DL This review article summarizes the structure, signalling pathways, and tissue distribution of the vasopressin receptors, V1 vascular, V2 renal, V3 pituitary, and oxytocin receptors, as well as the P2 class of purinoceptors. The physiological effects of vasopressin on its receptors are described. The future direction with regard to the role of the V1a receptor in circulatory shock states is discussed; further studies with V1a receptor agonists are warranted to further develop treatment strategies to reduce mortality in life threatening diseases like septic shock. PMID: 18683472 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689544 Sun, 01 Jun 2008 04:00:00 +0100 1689544 http://www.medworm.com/index.php?rid=1689543&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683473%26dopt%3DAbstract Authors: Sharshar T, Annane D Vasopressin, also called antidiuretic hormone, is a 9 amino-acid peptide, synthesized from a precursor containing neurophysin II, by neurones from the supra-optic and peri-ventricular nuclei, and then stored in the posterior hypophysis. Vasopressin regulates plasmatic osmolality and volaemia via V2 receptors at the levels of the kidney, and vascular smooth muscle tone via V1a arterial receptors. Both its synthesis and release from hypophysis vesicles depend on variations in plasma osmolality, volaemia, and arterial blood pressure. In addition, vasopressin interacts with the main hormonal systems involved in the response to stress, including the hypothalamic-pituitary adrenal axis, other anterior pituitary hormones, mainly prolactin and growth hormone, the ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689543 Sun, 01 Jun 2008 04:00:00 +0100 1689543 http://www.medworm.com/index.php?rid=1689542&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683474%26dopt%3DAbstract Authors: Holmes CL, Walley KR Vasodilatory septic shock is characterized by profound vasodilation of the peripheral circulation, relative refractoriness to catecholamines and a relative deficiency of the posterior pituitary hormone, vasopressin. Arginine vasopressin is effective in restoring vascular tone in vasodilatory septic shock and may be associated with decreased mortality in less severe septic shock as well as improved mortality and decreased renal failure in septic shock patients at risk for renal failure. PMID: 18683474 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689542 Sun, 01 Jun 2008 04:00:00 +0100 1689542 http://www.medworm.com/index.php?rid=1689541&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683475%26dopt%3DAbstract Authors: Wenzel V, Raab H, Dünser MW Arginine vasopressin (AVP) constitutes an integral part of the neuroendocrine stress response during cardiac arrest. A strong correlation between endogenous AVP secretion and outcome from cardiac arrest has led to a number of experimental studies indicating a survival benefit of AVP compared to epinephrine. In the clinical setting, however, things are less clear. Although current data suggest that both epinephrine and AVP are equally effective to restore spontaneous circulation in out-of-hospital cardiac arrest, benefits of AVP in specific patient groups, e.g. those with asystolic cardiac arrest, have been shown. The latest international guidelines recommend AVP as an alternative vasopressor drug which may replace the first or second dosage of ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689541 Sun, 01 Jun 2008 04:00:00 +0100 1689541 http://www.medworm.com/index.php?rid=1689540&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683476%26dopt%3DAbstract Authors: Wenzel V, Raab H, Dünser MW Haemorrhagic shock is one of the most frequent types of shock. If haemorrhage cannot be controlled and fluid resuscitation as well as catecholamines are insufficient to stabilize cardiovascular function, uncontrolled haemorrhagic shock occurs. Several approaches have been suggested as promising alternatives to volume resuscitation. The rationale for the use of arginine vasopressin (AVP) is the pharmacologic amplification of the neuroendocrine stress response. AVP-mediated vasoconstriction is the first physiologic step to haemostasis and shifts blood away from the bleeding site towards the heart, lungs and brain. Particularly, when uncontrolled haemorrhage is accompanied by traumatic brain injury this may help to reduce secondary neurological da... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689540 Sun, 01 Jun 2008 04:00:00 +0100 1689540 http://www.medworm.com/index.php?rid=1689539&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683477%26dopt%3DAbstract Authors: Morelli A, Ertmer C, Westphal M Terlipressin, a long-acting vasopressinergic V1 agonist, is increasingly used to increase mean arterial blood pressure in the common setting of catecholamine-refractory septic shock. Traditionally, terlipressin has been used as drug of last resort and administered as intermittent high-dose bolus infusion (1-2 mg every 4 to 6 hours). Recent experimental and clinical evidence, however, suggests that terlipressin may also be used as a low-dose continuous infusion (1-2 microg kg(-1) h(-1)) in the early course of the disease. This approach may sufficiently increase systemic blood pressure and thereby prevent unwanted side effects, such as exaggerating increases in peripheral resistance or rebound hypotension. Small-scale clinical studies suggest that... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689539 Sun, 01 Jun 2008 04:00:00 +0100 1689539 http://www.medworm.com/index.php?rid=1689538&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683478%26dopt%3DAbstract Authors: Leone M, Martin C The present paper is aimed at reviewing new findings on the use of terlipressin in children with septic shock. The level of evidence based on the data available in the literature is very low. Three series of cases and four isolated cases report on the use of terlipressin in children with catecholamine-refractory septic shock. The aggregated population represents 39 children. The dosages of boli vary from 7 microg/kg twice a day to 2 microg/kg every 4 hours. Low-dose continuous infusion has also been described. Terlipressin injection is associated with an approximately 30% increase in blood pressure. Mortality of these children with catecholamine refractory septic shock is 54%. The paucity of most reports does not make it possible to conclude on the global and... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689538 Sun, 01 Jun 2008 04:00:00 +0100 1689538 http://www.medworm.com/index.php?rid=1689537&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683479%26dopt%3DAbstract Authors: Döhler KD, Meyer M Bleeding of oesophageal varices and hepatorenal syndrome are most dramatic complications in gastroenterology. They develop in consequence of progressively increasing blood flow entering the vasodilated splanchnic bed and the portal vein where blood flow meets intrahepatic resistance. Porto-systemic collateral veins are formed to bypass the cirrhotic liver. Intravascular pressure is very high in these collaterals, causing the venous walls to expand into esophageal varices, which eventually may rupture and bleed. This splanchnic blood pooling generates hypovolemia in the central and arterial system, initiating activation of the renin-angiotensin-aldosteron and sympathetic nervous system. These compensatory mechanisms induce renal vasoconstriction, followe... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689537 Sun, 01 Jun 2008 04:00:00 +0100 1689537 http://www.medworm.com/index.php?rid=1689536&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683480%26dopt%3DAbstract Authors: Asfar P, Bracht H, Radermacher P Given the controversial experimental and clinical data reported in the literature, up to now it is rather difficult to draw a definitive conclusion on the effects of V1 agonists on splanchnic haemodynamics. Nevertheless, it must be underscored that most of the experimental studies assessing the effects of low dose V1 agonist infusion in hyperdynamic models did not demonstrate any detrimental effect on splanchnic haemodynamics both at macro- and microcirculatory levels. Interestingly, all the reported studies focused on macro- and microcirculatory haemodynamics, while only some also addressed the local oxygenation and metabolism. In clinical studies in patients with septic shock, data are accumulating regarding the absence of clinically relevant... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689536 Sun, 01 Jun 2008 04:00:00 +0100 1689536 http://www.medworm.com/index.php?rid=1689535&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683481%26dopt%3DAbstract Authors: Singer M The synthetic vasopressin analogue, terlipressin, is being increasingly used to treat catecholamine-resistant hypotension in septic shock and other conditions. While terlipressin holds some theoretical and anecdotal advantages over vasopressin, this has not been formally tested in prospective randomised trials. This review analyses the published literature and makes comparisons, where possible, between vasopressin and terlipressin. PMID: 18683481 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689535 Sun, 01 Jun 2008 04:00:00 +0100 1689535 http://www.medworm.com/index.php?rid=1689534&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683482%26dopt%3DAbstract Authors: Lange M, Van Aken H, Westphal M, Morelli A Three pathways are critically involved in blood pressure regulation during anaesthesia, i.e. the sympathetic nervous system, the renin angiotensin system (RAS), and the vasopressinergic system. The fact that anaesthetic agents typically blunt the regulatory role of the adrenergic system emphasises the importance of the remaining compensatory mechanisms. In patients chronically treated with RAS antagonists, such as angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists, however, this mechanism is also blunted, possibly resulting in absolute dependency of blood pressure regulation on the vasopressinergic system. To date, several small-scale clinical trials demonstrated the efficacy of V1 receptor agonists in re... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689534 Sun, 01 Jun 2008 04:00:00 +0100 1689534 http://www.medworm.com/index.php?rid=1689533&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683483%26dopt%3DAbstract Authors: Jochberger S, Dünser MW Epidural anaesthesia is a well-established and recognized technique in anaesthetic practice. Its benefits are multiple and range from positive effects on the respiratory and cardiocirculatory system, a reduced need for analgesics and decreased costs to earlier hospital discharge. Disadvantages like sympathetic blockade followed by hypotension, bradycardia, and cardiac arrest, however, must be taken into consideration. Treatment of these side effects consists of fluid infusion and vasopressor drugs. During epidural anaesthesia, plasma arginine vasopressin (AVP) concentrations are increased. In case reports and a small clinical study, administration of AVP or one of its analogues could rapidly reverse hypotension and restore cardiovascular stability.... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689533 Sun, 01 Jun 2008 04:00:00 +0100 1689533 http://www.medworm.com/index.php?rid=1689532&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18683484%26dopt%3DAbstract Authors: Ertmer C, Rehberg S, Westphal M Vasopressin analogues are increasingly used for haemodynamic support of catecholamine-refractory, hyperdynamic septic shock. Arginine vasopressin (AVP) and terlipressin (TP) effectively increase mean arterial pressure and reduce catecholamine requirements in this condition. However, the use of either of the drugs may be linked to relevant haemodynamic side effects, including reductions in cardiac output, oxygen delivery and mixed-venous oxygen saturation. These alterations may result in impaired tissue perfusion and foster the genesis of ischemic tissue injury. In addition, decreases in platelet count and increases in aminotransferases activity and bilirubin concentration have been reported with the use of V1 agonists. However, it remains unclea... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1689532 Sun, 01 Jun 2008 04:00:00 +0100 1689532 http://www.medworm.com/index.php?rid=1503111&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494385%26dopt%3DAbstract Authors: Zaugg M PMID: 18494385 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503111 Sat, 01 Mar 2008 05:00:00 +0100 1503111 http://www.medworm.com/index.php?rid=1503110&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494386%26dopt%3DAbstract Authors: Vernick W, Fleisher LA Perioperative cardiac complications pose the greatest risk to the estimated 100 million people undergoing non-cardiac surgery each year. Most of these complications are related to underlying pre-existing coronary artery disease (CAD). For over 40 years researchers have been studying perioperative cardiac risk and how best to estimate it. The goal of improved risk stratification is important for allowing accurate informed decision-making, both by the patient and their physicians. Risk stratification has taken on an important role in clinical decision-making, helping physicians decide in which patients additional medical therapies, such as coronary revascularization or perioperative beta-blockers, are necessary. Meta-analysis has found a significant improv... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503110 Sat, 01 Mar 2008 05:00:00 +0100 1503110 http://www.medworm.com/index.php?rid=1503109&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494387%26dopt%3DAbstract Authors: Schwinn DA, Podgoreanu M Genomic medicine has provided new mechanistic understanding for many complex diseases over the last 5-10 years. More recently genomic approaches have been applied to the perioperative paradigm, facilitating identification of patients at high risk for adverse events, as well as those who will respond better/worse to specific pharmacologic therapies. The consistent biological theme emerging is that while inflammation is important in healing from surgical trauma, patients who are too robustly proinflammatory appear to be at higher risk for adverse perioperative events. Precise predictors of each adverse event are being elucidated so that corrective therapeutics can be instituted to improve outcomes in high-risk patients. While the field of perioperative g... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503109 Sat, 01 Mar 2008 05:00:00 +0100 1503109 http://www.medworm.com/index.php?rid=1503108&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494388%26dopt%3DAbstract Authors: Kurz A Perioperative hypothermia is a common and serious complication of anesthesia and surgery. Core body temperature, which is normally regulated to within a few tenths of a degree centigrade, can fall by as much as 6 degrees C during anesthesia. The combination of anesthetic-induced impairment of thermoregulatory control and exposure to a cool operating room environment causes most surgical patients to become hypothermic. Mild intraoperative hypothermia triples the incidence of postoperative wound infections, triples the incidence of postoperative myocardial events and increases perioperative blood loss. Furthermore, it prolongs postoperative recovery and prolongs the duration of action of almost all anesthestic drugs. Effective methods are available for preventing inadvert... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503108 Sat, 01 Mar 2008 05:00:00 +0100 1503108 http://www.medworm.com/index.php?rid=1503107&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494389%26dopt%3DAbstract Authors: Kocian R, Spahn DR Under normal conditions, only 20-30% of the delivered oxygen is metabolised. In normovolaemic anaemia, the organism reacts with increases in cardiac output and oxygen extraction. Once these mechanisms are exceeded, allogeneic blood transfusions may be administered. However, such transfusions are associated with serious adverse effects and alternatives such as artificial oxygen carriers are being sought. The main groups of artificial oxygen carriers are extracellular haemoglobin solutions and perfluorocarbons. Preparations undergoing experimental and clinical assessment include Human Polymerized Haemoglobin (Polyheme), Polymerized Bovine Haemoglobin-based Oxygen Carrier (HBOC-201, Hemopure), Haemoglobin Raffimer (HemoLink), Diaspirin Cross-linked Haemoglobin ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503107 Sat, 01 Mar 2008 05:00:00 +0100 1503107 http://www.medworm.com/index.php?rid=1503106&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494390%26dopt%3DAbstract Authors: Metzler H, Kozek-Langenecker S, Huber K New trends in interventional cardiology, e.g. the increasing practice of coronary intervention with stent implantation and the prolonged use of dual antiplatelet therapy--usually a combination of clopidogrel and aspirin--has also increased the number of patients presenting for non-cardiac surgery. The two most commonly used stent types, bare-metal stents (BMSs) and drug-eluting stents (DESs), mandate different lengths of dual antiplatelet drug therapy to avoid stent thrombosis. Perioperative caregivers face a knife-edge dilemma between perioperative stent thrombosis, due to preoperative discontinuation of antiplatelet drugs, or surgical bleeding, by continuation of therapy. Pre- and intraoperatively, the risk factors for thrombosis have ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503106 Sat, 01 Mar 2008 05:00:00 +0100 1503106 http://www.medworm.com/index.php?rid=1503105&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494391%26dopt%3DAbstract Authors: London MJ Perioperative beta blockade or the use of alpha2 agonists remains a contentious and controversial area of perioperative medicine. Although there is no question that the liberal use of beta blockers (or alpha2 agonists) to prevent or reduce overt signs of sympathetic overactivity, particularly at known periods of stress (e.g. induction, incision, emergence, etc) is an important and routine part of the management of high risk patients, there remains considerable controversy in the literature regarding the efficacy of either short or long-term regimens on cardiac morbidity or long-term outcomes, particularly in those patients not previously receiving medication for known coronary artery disease or hypertension. The role of strict heart rate control (and its safety with ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503105 Sat, 01 Mar 2008 05:00:00 +0100 1503105 http://www.medworm.com/index.php?rid=1503104&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494392%26dopt%3DAbstract Authors: Howard-Alpe G, Foëx P, Biccard B Statins are widely used in the prevention of atheromatous disease and its complications. While their lipid lowering effects are very important, there is increasing emphasis on the other effects of statins described as pleiotropic. These include atheromatous plaque stabilisation generally ascribed to their anti-inflammatory properties. It is increasingly clear that perioperative cardiac events relate to both haemodynamic perturbations (with imbalance between oxygen demand and oxygen supply to the myocardium), and rupture/disruption of atheromatous plaques. Thus, the effects of statins on perioperative cardiac outcome have been studied, mostly in observational studies. The majority of the studies have shown benefits of statin therapy. The re... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503104 Sat, 01 Mar 2008 05:00:00 +0100 1503104 http://www.medworm.com/index.php?rid=1503103&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494393%26dopt%3DAbstract Authors: Berkers J, Gunst J, Vanhorebeek I, Van den Berghe G The concept of stress hyperglycaemia as an adaptive, beneficial response in critical illness has recently been challenged. Two large prospective randomized controlled trials in the Leuven University Hospital surgical and medical ICUs demonstrated that maintenance of normoglycaemia with intensive insulin therapy substantially prevents morbidity and reduces mortality. Strict normoglycaemia is required to gain most clinical benefit. With this therapy the risk of hypoglycaemia increased, but without inducing obvious clinical sequellae. Other studies have been used to advocate against implementation of intensive insulin therapy by showing lack of benefit or questioning safety. However, these studies are inconclusive on this subjec... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503103 Sat, 01 Mar 2008 05:00:00 +0100 1503103 http://www.medworm.com/index.php?rid=1503102&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494394%26dopt%3DAbstract Authors: Shim YH, Kersten JR Activation of endogenous signal transduction pathways, by a variety of stimuli including ischemic and anesthetic pre- and post-conditioning, protects myocardium against ischemia and reperfusion injury. Experimental evidence suggests that adenosine-regulated potassium channels, cyclooxygenase-2, intracellular kinases, endothelial nitric oxide synthase, and membrane bound receptors play critical roles in signal transduction, and that intracellular signaling pathways ultimately converge on mitochondria to produce cardioprotection. Disease states, and perioperative medications such as sulfonylureas and COX-2 antagonists, could have adverse effects on cardioprotection by impairing activation of ion channels and proteins that are important in cell signaling. Insi... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503102 Sat, 01 Mar 2008 05:00:00 +0100 1503102 http://www.medworm.com/index.php?rid=1503101&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494395%26dopt%3DAbstract Authors: Sturgess J, Matta B The ability to reduce brain injury before, during or after an ischaemic injury, irrespective of the cause, remains an exciting prospect. In this article, we will discuss some of the current research behind cerebral protection, which will include the use of anaesthetic agents, as well as therapies targeted specifically at the complex cascades following brain injury. PMID: 18494395 [PubMed - in process] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503101 Sat, 01 Mar 2008 05:00:00 +0100 1503101 http://www.medworm.com/index.php?rid=1503100&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494396%26dopt%3DAbstract Authors: Slinger P Patients are at risk for several types of lung injury in the perioperative period. These injuries include atelectasis, pneumonia, pneumothorax, bronchopleural fistula, acute lung injury and acute respiratory distress syndrome. Anesthetic management can cause, exacerbate or ameliorate most of these injuries. Clinical research trends show that traditional protocols for perioperative mechanical ventilation, using large tidal volumes without positive end-expiratory pressure (PEEP) can cause a sub-clinical lung injury and this injury becomes clinically important when any additional lung injury is added. Lung-protective ventilation strategies using more physiologic tidal volumes and appropriate levels of PEEP can decrease the extent of this injury. PMID: 18494396 [PubM... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503100 Sat, 01 Mar 2008 05:00:00 +0100 1503100 http://www.medworm.com/index.php?rid=1503099&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494397%26dopt%3DAbstract Authors: Jones DR, Lee HT Acute kidney injury (AKI) is a significant cause of perioperative patient morbidity and mortality. The definition of AKI has recently changed and further research is underway to identify clinically relevant biomarkers to aid in the diagnosis of the syndrome. AKI is often multi-factorial in origin and patients with certain preoperative risk factors are at elevated risk of perioperative AKI. An anesthesiologist's main objective for perioperative renal protection is prevention by maintenance of euvolemia, preservation of adequate renal perfusion, and avoidance of nephrotoxins. This review will address the definition and diagnosis of AKI, identify patients at risk of AKI, and critically appraise management options for perioperative renal protection. PMID: 1849... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503099 Sat, 01 Mar 2008 05:00:00 +0100 1503099 http://www.medworm.com/index.php?rid=1503098&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494398%26dopt%3DAbstract Authors: Picker O, Beck C, Pannen B With recent advances in surgical and anaesthetic management, clinical medicine has responded to societal expectations and the number of operations in patients with a high-risk of perioperative liver failure has increased over the last decades. This review will outline important pathophysiological alterations common in patients with pre-existing liver impairment and thus highlight the anaesthetic challenge to minimise perioperative liver insults. It will focus on the intraoperative balancing act to reduce blood loss while maintaining adequate liver perfusion, the various anaesthetic agents used and their specific effects on hepatic function, perfusion and toxicity. Furthermore, it will discuss advances in pharmacological and ischaemic preconditioning ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503098 Sat, 01 Mar 2008 05:00:00 +0100 1503098 http://www.medworm.com/index.php?rid=1503097&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18494399%26dopt%3DAbstract Authors: Herijgers P, Flameng WJ Preserving donor organs in optimal condition is a prerequisite for successful transplantation. The donor organ is subjected to a multitude of stresses. In this review, we will discuss the consequences of brain death on donor organs. The effects of an extended ischaemic period followed by the reperfusion necessary for the harvest, storage and implantation of transplant organs will be evaluated. As progressively more is known about the underlying pathophysiological mechanisms, focused and efficient therapeutic interventions can be developed. We will review current organ protection techniques and look at possible future strategies to further improve the final donor organ quality. PMID: 18494399 [PubMed - in process] (Source: Best Practice and Research.... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503097 Sat, 01 Mar 2008 05:00:00 +0100 1503097 http://www.medworm.com/index.php?rid=1503121&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286829%26dopt%3DAbstract Authors: Himmelseher S, Kochs EF PMID: 18286829 [PubMed - indexed for MEDLINE] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503121 Sat, 01 Dec 2007 05:00:00 +0100 1503121 http://www.medworm.com/index.php?rid=1503120&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286830%26dopt%3DAbstract Authors: Fàbregas N, Bruder N Recovery from general anaesthesia is a period of intense stress for patients: there is sympathetic activation, catecholamine release, and increase in blood pressure or heart rate. Stressful events increase cerebral blood flow and cerebral oxygen consumption, potentially producing elevation of intracranial pressure and thus, favouring cerebral insults. Measures to prevent agitation, hypertension, shivering, and coughing are therefore very well justified in neurosurgical patients. The rationale for a "rapid-awakening-strategy" after craniotomy with general anaesthesia is that an early diagnosis of postoperative neurological complications is essential to limit potentially devastating consequences and finally improve patient outcome. A trial of early reco... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503120 Sat, 01 Dec 2007 05:00:00 +0100 1503120 http://www.medworm.com/index.php?rid=1503119&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286831%26dopt%3DAbstract Authors: Pfister D, Strebel SP, Steiner LA Postoperative neurosurgical patients are at risk of developing complications. Systemic and neuro-monitoring are used to identify patients who deteriorate in order to treat the underlying cause and minimize the impact on outcome. Hypotension and hypoxia are likely to be the most frequent insults and can be detected easily with blood pressure monitoring and pulse oximetry. Repeated clinical examination, however, is probably the most important monitor in the postoperative setting. Clinical scores such as the Glasgow Coma Score and the more recently introduced FOUR Score are important tools to standardize the clinical assessment. Intracranial pressure monitoring, cerebral blood flow monitoring, electroencephalography, and brain imaging are often u... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503119 Sat, 01 Dec 2007 05:00:00 +0100 1503119 http://www.medworm.com/index.php?rid=1503118&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286832%26dopt%3DAbstract Authors: Rozet I, Domino KB PURPOSE OF THE REVIEW: Neurosurgical patients frequently develop respiratory complications, adversely affecting neurologic outcome and survival. The review summarizes current literature and management of respiratory complications associated with brain injury. MAJOR FINDINGS: Respiratory complications are commonly associated with traumatic brain injury and subarachnoid haemorrhage. Lung-protective ventilation with reduced tidal volumes improves outcome in acute lung injury, and should be applied to neurosurgical patients in the absence of increased intracranial pressure. Weaning from the mechanical ventilation should be initiated as soon as possible, although the role of neurological status in the weaning process is not clear. Prevention of pneumonia and aspi... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503118 Sat, 01 Dec 2007 05:00:00 +0100 1503118 http://www.medworm.com/index.php?rid=1503117&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286833%26dopt%3DAbstract Authors: Schubert A The causes of postoperative cardiovascular disturbances in neurosurgical patients include direct cardiac neurogenic effects, clinical situations where brain tissue is underperfused, and hyperdynamic states. EKG and echographic abnormalities are common in subarachnoid hemorrhage where cardiac troponin I is the most useful predictor of cardiac risk after SAH. Neurogenic pulmonary edema is short lived and often resolves with resolution of the neurologic problem. In traumatic brain injury, where areas of ischemia co-exist with luxury perfusion, advanced hemodynamic monitoring and prevention of jugular venous desaturation best avoid secondary brain injury and achieve optimal neurologic outcome. Induced hypertension improves blood flow through vessels compromised by cereb... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503117 Sat, 01 Dec 2007 05:00:00 +0100 1503117 http://www.medworm.com/index.php?rid=1503116&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286834%26dopt%3DAbstract Authors: Tommasino C, Picozzi V Osmolality is the primary determinant of water movement across the intact blood-brain barrier (BBB), and we can predict that reducing serum osmolality would increase cerebral oedema and intracranial pressure. Brain injury affects the integrity of the BBB to varying degrees. With a complete breakdown of the BBB, there will be no osmotic/oncotic gradient, and water accumulates (brain oedema) consequentially to the pathological process. In regions with very moderate BBB injury, the oncotic gradient may be effective. Finally, osmotherapy is effective in brain areas with normal BBB; hypertonic solutions (mannitol, hypertonic saline) dehydrate normal brain tissue, with a decrease in cerebral volume and intracranial pressure. In patients with brain pathology, v... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503116 Sat, 01 Dec 2007 05:00:00 +0100 1503116 http://www.medworm.com/index.php?rid=1503115&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286835%26dopt%3DAbstract Authors: Jantzen JP Intracranial pressure (ICP) is the pressure exerted by cranial contents on the dural envelope. It comprises the partial pressures of brain, blood and cerebrospinal fluid (CSF). Normal intracranial pressure is somewhere below 10 mmHg; it may increase as a result of traumatic brain injury, stroke, neoplasm, Reye's syndrome, hepatic coma, or other pathologies. When ICP increases above 20 mmHg it may damage neurons and jeopardize cerebral perfusion. If such a condition persists, treatment is indicated. Control of ICP requires measurement, which can only be performed invasively. Standard techniques include direct ventricular manometry or measurement in the parenchyma with electronic or fiberoptic devices. Displaying the time course of pressure (high-resolution ICP tonosc... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503115 Sat, 01 Dec 2007 05:00:00 +0100 1503115 http://www.medworm.com/index.php?rid=1503114&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286836%26dopt%3DAbstract Authors: Tolani KA, Bendo AA Prevention and treatment of homeostatic disorders after central neurosurgical procedures requires a coordinated effort by the entire medical team caring for the patient. The goal of management is to optimize physiologic and metabolic variables so that patient outcome is improved. This chapter reviews current knowledge and clinical approaches to prevention and treatment of general homeostatic disorders that commonly complicate the postoperative course of neurosurgical patients after general anesthesia. Practice recommendations based on current clinical trials and experience will be made on the following topics: therapeutic approaches to optimal hemoglobin, cerebral blood flow and hemorrheology; prophylaxis and treatment of thrombosis; temperature management ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503114 Sat, 01 Dec 2007 05:00:00 +0100 1503114 http://www.medworm.com/index.php?rid=1503113&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286837%26dopt%3DAbstract Authors: Nemergut EC, Durieux ME, Missaghi NB, Himmelseher S Fear of the side effects of analgesic drugs frequently leads to the under-treatment of post-craniotomy pain. Nevertheless, this pain continues to be commonly observed, is frequently severe, and, if unrelieved, may cause distress for the neurosurgical patient and serious complications for the operative brain. We review recent evidence-based data on pain therapy after intracranial surgery. Especially when performed at the end of surgery, local anaesthetic scalp infiltration provides adequate, short-term postoperative pain relief. Opioids, such as morphine or oxycodone, may be used in the early period after craniotomy. If titrated properly, opioids do not increase serious side effects as compared with codeine. The non-narcotics ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503113 Sat, 01 Dec 2007 05:00:00 +0100 1503113 http://www.medworm.com/index.php?rid=1503112&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18286838%26dopt%3DAbstract Authors: Eberhart LH, Morin AM, Kranke P, Missaghi NB, Durieux ME, Himmelseher S Postoperative nausea and vomiting (PONV) are the most frequent side-effects in the postoperative period, impairing subjective well-being and having economic impact due to delayed discharge. However, emetic symptoms can also cause major medical complications, and post-craniotomy patients may be at an increased risk. A review and critical appraisal of the existing literature on PONV in post-craniotomy patients, and a comparison of these findings with the current knowledge on PONV in the general surgical population, leads to the following conclusions: (1) Despite the lack of a documented case of harm caused by retching or vomiting in a post-craniotomy patient, the potential risk caused by arterial hypertensio... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503112 Sat, 01 Dec 2007 05:00:00 +0100 1503112 http://www.medworm.com/index.php?rid=1503131&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900009%26dopt%3DAbstract Authors: Leslie K PMID: 17900009 [PubMed - indexed for MEDLINE] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503131 Sat, 01 Sep 2007 04:00:00 +0100 1503131 http://www.medworm.com/index.php?rid=1503130&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900010%26dopt%3DAbstract Authors: Veselis RA Episodic memory is the most 'human' of all memory systems, is integrally related to the hippocampus, and not only permits memories of the past in rich detail, but also allows projection of thoughts into the future. However, episodic memory is very sensitive to anaesthetic drugs and cannot be formed during adequate general anaesthesia. Ablation of episodic memory during consciousness is due to forgetting of memories, rather than inhibition of memory formation. There is a fine balance between being conscious with recollection and conscious with no recollection. A more detailed understanding of episodic memory in relation to other memory systems, as well as the relationship of the hippocampus to episodic memory function is provided. A synthesis of diverse knowledge is ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503130 Sat, 01 Sep 2007 04:00:00 +0100 1503130 http://www.medworm.com/index.php?rid=1503129&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900011%26dopt%3DAbstract Authors: Voss L, Sleigh J Direct and indirect inhibitory effects of anaesthetic agents on cortical activity are reflected in the electroencephalogram (EEG) as: (i) a shift from low-amplitude, high-frequency EEG, to high-amplitude, low-frequency activity (indicative of cortical depowering) and; (ii) the appearance of spindles and K-complexes (indicative of thalamocortical hyperpolarisation and sensory blockade). Existing EEG monitors use cortical activity as a proxy measure for consciousness. However the state of the cortex at any given moment does not accurately predict the state that it will enter in response to a noxious stimulus, and EEG monitors do not differentiate well between different levels of rousability. Also the literature reveals many instances where the EEG pattern is dis... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503129 Sat, 01 Sep 2007 04:00:00 +0100 1503129 http://www.medworm.com/index.php?rid=1503128&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900012%26dopt%3DAbstract Authors: Ghoneim MM Explicit recall of events during general anaesthesia is detected by direct questioning, as patients may not report awareness spontaneously or if they are questioned non-specifically. More than one interview is needed and credibility of reports should always be verified. The overall incidence of awareness has decreased over the last 40 years and is now 0.1-0.2%. Prospective study of patients who undergo general anaesthesia is the only valid method for determining the incidence of awareness. Studies of patients recruited through referrals by colleagues or advertisements, studies of compensation claims and those carried out through quality improvement systems are inadequate. Several factors increase the risk of awareness, including light anaesthesia, some types of surg... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503128 Sat, 01 Sep 2007 04:00:00 +0100 1503128 http://www.medworm.com/index.php?rid=1503127&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900013%26dopt%3DAbstract Authors: Myles PS Inadequate anaesthesia may lead to awareness. A properly trained anaesthetist, administering anaesthesia according to their knowledge of pharmacology and patient and surgical characteristics, assisted by clinical signs and monitoring, can minimize this risk. Relying upon volatile-based anaesthesia delivered at a concentration of at least 0.5 MAC may be effective, but this precludes the use of total intravenous anaesthesia techniques and in any case may lead to unwanted hypotension. Equipment failure may occur. Benzodiazepines do not protect the patient from awareness. The development of electroencephalographic monitors of anaesthetic depth provides an opportunity to prevent awareness. Two large scale studies, one of which was a randomized trial, have identified a 5-fo... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503127 Sat, 01 Sep 2007 04:00:00 +0100 1503127 http://www.medworm.com/index.php?rid=1503126&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900014%26dopt%3DAbstract Authors: Lennmarken C, Sydsjo G Intraoperative awareness with subsequent recall is a rare but serious complication with an incidence of 0.1-0.2%. In approximately one third of the patients who have experienced awareness, late severe psychiatric sequelae may develop. The psychiatric symptoms in these patients fulfil the diagnostic criteria for post traumatic stress disorder. To prevent awareness as a negative outcome after anaesthesia, a thorough perioperative management of anaesthesia is necessary. The definite risk for post traumatic stress disorder following awareness indicates the necessity of postoperative clinical routines to identify awareness patients. The problem must be acknowledged. Professional psychiatric assessment and follow up should constitute standard practice. The tre... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503126 Sat, 01 Sep 2007 04:00:00 +0100 1503126 http://www.medworm.com/index.php?rid=1503125&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900015%26dopt%3DAbstract Authors: Kent CD, Domino KB Increased attention in recent years in both the academic literature and general media on awareness during general anaesthesia has raised the spectre of an increase in the liability burden of anaesthesia awareness. Liability will be different around the world, largely influenced by factors such as the presence of no-fault compensation systems for medical complications in some countries and the characteristics of the common law tort systems in others, such as the United States. A review of the largest single source for liability data, the American Society of Anesthesiologists' Closed Claims database, found the proportion of anaesthesia malpractice claims and claim payment amounts for awareness did not increase during the 1990s. However, due to the time lag to ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503125 Sat, 01 Sep 2007 04:00:00 +0100 1503125 http://www.medworm.com/index.php?rid=1503124&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900016%26dopt%3DAbstract Authors: Andrade J, Deeprose C Do patients form memories of intra-operative events when they are adequately anaesthetized? Studies of memory priming during anaesthesia with depth or awareness monitoring provide some evidence that they do, although only the most basic form of memory function, perceptual priming, persists when patients are unconscious. The probability of memory encoding increases as depth of anaesthesia decreases. There is a theoretical possibility that patients can be adversely affected, through memory priming, by comments made in the operating theatre, and some evidence that positive intra-operative suggestions can benefit patients. PMID: 17900016 [PubMed - indexed for MEDLINE] (Source: Best Practice and Research. Clinical Anaesthesiology) Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503124 Sat, 01 Sep 2007 04:00:00 +0100 1503124 http://www.medworm.com/index.php?rid=1503123&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900017%26dopt%3DAbstract Authors: Leslie K, Skrzypek H Dreaming during anaesthesia is defined as any recalled experience (excluding awareness) that occurred between induction of anaesthesia and the first moment of consciousness upon emergence. Dreaming is a commonly-reported side-effect of anaesthesia. The incidence is higher in patients who are interviewed immediately after anaesthesia (approximately 22%) than in those who are interviewed later (approximately 6%). A minority of dreams, which include sensory perceptions obtained during anaesthesia, provide evidence of near-miss awareness. These patients may have risk factors for awareness and this type of dreaming may be prevented by depth of anaesthesia monitoring. Most dreaming however, occurs in younger, fitter patients, who have high home dream recall, who... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503123 Sat, 01 Sep 2007 04:00:00 +0100 1503123 http://www.medworm.com/index.php?rid=1503122&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17900018%26dopt%3DAbstract Authors: Davidson AJ Recent studies have reported an incidence of awareness in children of around 1%, while older studies reported incidences varying from 0% to 5%. Measuring awareness in children requires techniques specifically adapted to a child's cognitive development and variations in incidence may be partly explained by the measures used. The causes and consequences of awareness in children remain poorly defined, though a consistent finding is that many children do not seem distressed by their memories. There are, however, some published reports of persistent psychological symptoms after episodes of childhood awareness. Compared to explicit memory, implicit memory is more robust in young children; however there is no evidence yet for implicit memory formation during anaesthesia i... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503122 Sat, 01 Sep 2007 04:00:00 +0100 1503122 http://www.medworm.com/index.php?rid=1503140&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650769%26dopt%3DAbstract Authors: Madjdpour C, Spahn DR Allogeneic red blood cell (RBC) transfusions have been shown to be associated with considerable risks. While their efficiency in many clinical situations has not been proven, the number of studies finding adverse outcomes in terms of morbidity (e.g. postoperative infections) and mortality continues to rise. In view of these facts, physicians involved in transfusion medicine have to be as restrictive as possible with RBC transfusions. Only a thorough knowledge of the physiology and pathophysiology of oxygen transport can be a solid base for meaningful transfusion decisions. Therefore, the goal of this article is to review the basics of oxygen transport and normovolaemic anaemia. PMID: 17650769 [PubMed - indexed for MEDLINE] (Source: Best Practice and R... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503140 Fri, 01 Jun 2007 04:00:00 +0100 1503140 http://www.medworm.com/index.php?rid=1503139&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650770%26dopt%3DAbstract Authors: Vallet B, Adamczyk S, Barreau O, Lebuffe G In clinical practice, the decision to transfuse is linked to the hope of increasing oxygen transport (TO2) to tissues. Physiologic transfusion triggers should progressively replace arbitrary hemoglobin-based transfusion triggers. These 'physiologic' transfusion triggers can be based on signs and symptoms of impaired global oxygenation (lactate, venous O2 saturation [SvO2]) or, even better, of regional tissue oxygenation (electrocardiographic ST-segment, electroencephalographic P300 latency). The SvO2 or its surrogate, the central venous 02 saturation (ScvO2), is a clinical tool which integrates the relationship between whole-body O2 uptake and TO2, and as such can be proposed as a simple physiologic transfusion trigger. PMID: 1765... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503139 Fri, 01 Jun 2007 04:00:00 +0100 1503139 http://www.medworm.com/index.php?rid=1503138&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650771%26dopt%3DAbstract Authors: Toy P, Lowell C Transfusion-related acute lung injury (TRALI) is defined as new acute lung injury (ALI) that occurs during or within six hours of transfusion, not explained by another ALl risk factor. Transfusion of part of one unit of any blood product can cause TRALI. The mechanism may include factors in unit(s) of blood, such as antibody and biologic response modifiers. In addition, yet to be described factors in a patient's illness may predispose to the condition. The current incidence is estimated to be 1 in 5000 units. Patients present with acute dyspnea, or froth in the endotracheal tube in intubated patients. Hypertension, hypotension, acute leukopenia have been described. Management is similar to that for ALI and is predominantly supportive. When TRALI is suspected, B... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503138 Fri, 01 Jun 2007 04:00:00 +0100 1503138 http://www.medworm.com/index.php?rid=1503137&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650772%26dopt%3DAbstract Authors: Almac E, Ince C Despite the common use of red-blood-cell transfusions in clinical practice, actual beneficial effects of red blood cells have never been demonstrated. On the contrary, several studies suggest that red-blood-cell transfusions are associated with higher risks of morbidity and mortality. The effects of the duration of storage on the efficacy of red blood cells have therefore been questioned in a number of studies. Recent insights into the physiology of red blood cells such as the role of the hypoxia-induced vasodilator-releasing function of red blood cells--is discussed in relation to the controversy surrounding the use of blood transfusions in clinical practice. PMID: 17650772 [PubMed - indexed for MEDLINE] (Source: Best Practice and Research. Clinical Anaest... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503137 Fri, 01 Jun 2007 04:00:00 +0100 1503137 http://www.medworm.com/index.php?rid=1503136&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650773%26dopt%3DAbstract Authors: Vincent JL, Sakr Y, De Backer D, Van der Linden P The majority of intensive care unit (ICU) patients will receive a blood transfusion at some point during the course of their ICU stay, generally in an attempt to increase oxygen delivery and hence tissue oxygenation. The efficacy of red blood cell (RBC) transfusion can be evaluated through its effects on patient mortality or morbidity, or more simply by its effects on tissue oxygenation. Review of the available literature shows controversial results, with some studies showing that RBC transfusion may be efficacious while others do not. The true challenge lies in determining which patients will benefit from transfusion and those in whom it may be safe to delay or withhold transfusion. In this article, several key factors influen... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503136 Fri, 01 Jun 2007 04:00:00 +0100 1503136 http://www.medworm.com/index.php?rid=1503135&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650774%26dopt%3DAbstract Authors: Pape A, Habler O Inherent risks and increasing costs of allogeneic transfusions underline the socioeconomic relevance of safe and effective alternatives to banked blood. The safety limits of a restrictive transfusion policy are given by a patient's individual tolerance of acute normovolaemic anaemia. latrogenic attempts to increase tolerance of anaemia are helpful in avoiding premature blood transfusions while at the same time maintaining adequate tissue oxygenation. Autologous transfusion techniques include preoperative autologous blood donation (PAD), acute normovolaemic haemodilution (ANH), and intraoperative cell salvage (ICS). The efficacy of PAD and ANH can be augmented by supplemental iron and/or erythropoietin. PAD is only cost-effective when based on a meticulous dona... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503135 Fri, 01 Jun 2007 04:00:00 +0100 1503135 http://www.medworm.com/index.php?rid=1503134&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650775%26dopt%3DAbstract Authors: Chassot PG, Delabays A, Spahn DR Performing a surgical procedure on a patient undergoing anti-platelet therapy raises a dilemma: is it safer to withdraw the drugs and reduce the haemorrhagic risk, or to maintain them and reduce the risk of myocardial ischaemic events? Based on recent clinical data, this review concludes that the risk of coronary thrombosis on anti-platelet drugs withdrawal is much higher than the risk of surgical bleeding when maintaining them. In secondary prevention, aspirin is a lifelong therapy and should never be stopped. Clopidogrel is mandatory as long as the coronary stents are not fully endothelialized, which takes 6-24 weeks depending on the technique used, but might be required for a longer period. PMID: 17650775 [PubMed - indexed for MEDLINE] (... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503134 Fri, 01 Jun 2007 04:00:00 +0100 1503134 http://www.medworm.com/index.php?rid=1503133&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650776%26dopt%3DAbstract Authors: Grottke O, Henzler D, Rossaint R According to the global study of the burden of disease, violence and accidental injury account for 12% of deaths worldwide; 30-40% of trauma mortality is attributable to haemorrhage. The highly complex haemostatic system is severely impaired as a result of haemorrhagic shock, acidosis, hypothermia, haemodilution, hyperfibrinolysis, and consumption of clotting factors. Thus it is important to prioritize the prevention of the development of coagulopathy. Timely transfusion of red blood cells and plasma products becomes essential to restore tissue oxygenation, support perfusion, and maintain the pool of active haemostatic factors. The limits to this strategy to compensate for the loss of blood and coagulation factors are discussed. In the absence ... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503133 Fri, 01 Jun 2007 04:00:00 +0100 1503133 http://www.medworm.com/index.php?rid=1503132&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17650777%26dopt%3DAbstract Authors: Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR Understanding the costs associated with blood products requires sophisticated knowledge about transfusion medicine and is attracting the attention of clinical and administrative healthcare sectors worldwide. To improve outcomes, blood usage must be optimized and expenditures controlled so that resources may be channeled toward other diagnostic, therapeutic, and technological initiatives. Estimating blood costs, however, is a complex undertaking, surpassing simple supply versus demand economics. Shrinking donor availability and application of a precautionary principle to minimize transfusion risks are factors that continue to drive the cost of blood products upward. Recognizing that historical accounting attempts to deter... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503132 Fri, 01 Jun 2007 04:00:00 +0100 1503132 http://www.medworm.com/index.php?rid=1503150&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17489216%26dopt%3DAbstract Authors: Pogatzki-Zahn EM, Zahn PK, Brennan TJ Postoperative incisional pain is a unique and common form of acute pain. Although ample evidence indicates that an efficeous postoperative pain treatment reduces patient morbidity and patient outcome, recent studies demonstrate that about 50-70% of patients experience moderate to severe pain after surgery indicating that postoperative pain remains poorly treated. Perhaps important reasons for this quandary are distinct mechanisms of incisional nociception compared to other pain conditions limiting our regimen to drugs designed for other clinical pain problems. Another reason might be the lack of an in depth knowledge about the pathophysiology and neuropharmacology of postoperative pain. Basic research offers important insights in the mecha... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503150 Thu, 01 Mar 2007 05:00:00 +0100 1503150 http://www.medworm.com/index.php?rid=1503149&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17489217%26dopt%3DAbstract Authors: Schug SA, Manopas A Non-opioids play an ever increasing role in the treatment of postoperative pain; either on their own for mild to moderate pain or in combination with other analgesic approaches, in particular opioids, as a component of multimodal analgesia. The analgesics paracetamol (acetaminophen) and dipyrone (metamizole) as well as compounds with an additional anti-inflammatory effect (non-selective non-steroidal anti-inflammatory drugs and selective cyclo-oxygenase-2 inhibitors) are used widely in the perioperative period. Paracetamol is gaining renewed interest in this setting due to its minimal adverse effects and recent availability in a parenteral preparation, but its benefits are insufficiently studied. Dipyrone continues to be used in many countries despite the o... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503149 Thu, 01 Mar 2007 05:00:00 +0100 1503149 http://www.medworm.com/index.php?rid=1503148&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17489218%26dopt%3DAbstract Authors: Buvanendran A, Kroin JS Adjuvants are compounds which by themselves have undesirable side-effects or low potency but in combination with opioids allow a reduction of narcotic dosing for postoperative pain control. Adjuvants are needed for postoperative pain management due to side-effects of opioid analgesics, which hinder recovery, especially in the increasingly utilized ambulatory surgical procedures. NMDA antagonists have psychomimetic side-effects at high doses, but at moderate doses do not cause stereotypic behavior but allow reduction in opioid dose to obtain better pain control. Alpha-2 adrenergic agonists cause sedation, hypotension and bradycardia at moderate doses, but at low doses can be opioid sparing especially in spinal administration. Gabapentin-like compounds ha... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503148 Thu, 01 Mar 2007 05:00:00 +0100 1503148 http://www.medworm.com/index.php?rid=1503147&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17489219%26dopt%3DAbstract Authors: Grape S, Tramèr MR Preemptive analgesia means that an analgesic intervention is started before the noxious stimulus arises in order to block peripheral and central nociception. This afferent blockade of nociceptive impulses is maintained throughout the intra-operative and post-operative period. The goals of preemptive analgesia are, first, to decrease acute pain after tissue injury, second, to prevent pain-related pathologic modulation of the central nervous system, and third, to inhibit the persistence of postoperative pain and the development of chronic pain. So far, the promising results from animal models have not been translated into clinical practice. Therefore, clinicians should rely on conventional anaesthetic and analgesic methods with proven efficacy, i.e. a mul... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503147 Thu, 01 Mar 2007 05:00:00 +0100 1503147 http://www.medworm.com/index.php?rid=1503146&cid=s_37059_5_f&fid=37059&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17489220%26dopt%3DAbstract Authors: Koppert W, Schmelz M Clinical evidence suggests that--besides their well known analgesic activity - opioids can increase rather than decrease sensitivity to noxious stimuli. Based on the observation that opioids can activate pain inhibitory and pain facilitatory systems, this pain hypersensitivity has been attributed to a relative predominance of pronociceptive mechanisms. Acute receptor desensitization via uncoupling of the receptor from G-proteins, upregulation of the cAMP pathway, activation of the N-methyl-D-aspartate (NMDA)-receptor system, as well as descending facilitation, have been proposed as potential mechanisms underlying opioid-induced hyperalgesia. Numerous reports exist demonstrating that opioid-induced hyperalgesia is observed both in animal and human experimen... Best Practice and Research. Clinical Anaesthesiology journals http://www.medworm.com/rss/comments.php?id=1503146 Thu, 01 Mar 2007 05:00:00 +0100 1503146