Treading Through Twilight
(Source: Anesthesiology)
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Causes of Hypoxemia in COVID-19 Acute Respiratory Distress Syndrome: A Combined Multiple Inert Gas Elimination Technique and Dual-energy Computed Tomography Study
ConclusionsThese data support the hypothesis of a highly multifactorial genesis of hypoxemia. Moreover, recent evidence from post-mortem studies (i.e., opening of intrapulmonary bronchopulmonary anastomosis) may explain the findings regarding the postpulmonary shunting. The hyperperfusion might be related to the disease severity.Editor ’s PerspectiveWhat We Already Know about This TopicAlthough different mechanisms of hypoxemia in COVID-19 acute respiratory distress syndrome (ARDS) have been suggested, there is ongoing debate regarding the underlying pathophysiologyThe multiple inert gas elimination technique (MIGET) and...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Opposing Effects on Descending Control of Nociception by µ and κ Opioid Receptors in the Anterior Cingulate Cortex
ConclusionsAnterior cingulate cortex κ opioid receptor activation therefore diminishes descending control of nociception both in naive animals and as an adaptive response to chronic pain, likely by enhancing net descending facilitation. Descending control of nociception can be restored by activation of μ opioid receptors in the anter ior cingulate cortex, but also by κ opioid receptor antagonists, providing a nonaddictive alternative to opioid analgesics. Navacaprant is now in advanced clinical trials.Editor ’s PerspectiveWhat We Already Know about This TopicThe prevalence and severity of chronic pain are influenced b...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Monitoring of Argatroban in Critically Ill Patients: A Prospective Study Comparing Activated Partial Thromboplastin Time, Point-of-Care Viscoelastic Testing with Ecarin Clotting Time and Diluted Thrombin Time to Mass Spectrometry
ConclusionsAlthough activated PTT monitoring of argatroban is the most commonly used test, in critically ill patients, diluted TT provides more precise measurements. Alternately, point-of-care viscoelastic ecarin clotting time also provides guidance for argatroban dosing to identify overdosing if available. The data also suggested that patients with sepsis are at greater risk for argatroban overdosing.Editor ’s PerspectiveWhat We Already Know about This TopicIntravenous direct thrombin inhibitors, bivalirudin and argatroban, are indicated for treating heparin-induced thrombocytopenia and used off-label with heparin resis...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Meaning and Management of Perioperative Oliguria
Perioperative oliguria is an alarm signal. The initial assessment includes closer patient monitoring, evaluation of volemic status, risk –benefit analysis of fluid challenge or furosemide stress test, and investigation of possible perioperative complications. (Source: Anesthesiology)
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Perioperative Mortality of the COVID-19 Recovered Patient Compared to a Matched Control: A Multicenter Retrospective Cohort Study
ConclusionsPatients with a positive test for COVID-19 before elective surgery early in the pandemic have an elevated risk of perioperative mortality and pulmonary complications but not acute kidney injury as compared to matched controls. The span of time from positive test to time of surgery affected the mortality and pulmonary risk, which subsided after 2 weeks.Editor ’s PerspectiveWhat We Already Know about This TopicSurgical procedures performed on patients with recent exposure to COVID-19 infection have been associated with increased mortality riskWhat This Article Tells Us That Is NewIn a retrospective observational...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Target-controlled Infusion of Remimazolam in Healthy Volunteers Shows Some Acute Tolerance
ConclusionsIn this study, it was shown that remimazolam-induced sedation is prone to tolerance development, which is potentially mediated by the CNS7054 concentration. The clinical consequences are, however, limited in situations where remimazolam is titrated to effect.Editor ’s PerspectiveWhat We Already Know about This TopicRemimazolam is a short-acting benzodiazepine that is administered as repeated bolus doses for procedural sedation and as a continuous infusion for general anesthesia in adultsThe pharmacokinetics of remimazolam administered as a bolus dose as well as a continuous infusion have been well-characterize...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
The Walk
I ’m bound comfortably snug inside a cocoon of anesthesia. There’s nothing to see, to taste, to touch. Nothing hurts. Everything is starch and antiseptic. Out of the nothingness come pinpricks of sound. There is the hum of ventilation. I hear a voice say the phrase “wake up.” It cuts in betwee n the blips and beeps. The voice gets swallowed up in my narcotic haze. (Source: Anesthesiology)
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Increasing Levels of Positive End-expiratory Pressure Cause Stepwise Biventricular Stroke Work Reduction in a Porcine Model
ConclusionsA stepwise increase in PEEP caused stepwise reduction in biventricular stroke work. However, there are important interventricular differences in response to increased PEEP levels. PEEP increased right ventricular afterload leading to uncoupling and right ventricular ejection fraction decline. These findings may support clinical decision-making to further optimize PEEP as a means to balance between improving lung ventilation and preserving right ventricular function.Editor ’s PerspectiveWhat We Already Know about This TopicPositive end-expiratory pressure (PEEP) is commonly applied to avoid atelectasis and impr...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Prolonged Opioid Use and Pain after Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Prolonged Opioid Use and Pain after Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Prolonged Opioid Use and Pain after Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Association of Patient Race and Hospital with Utilization of Regional Anesthesia for Treatment of Postoperative Pain in Total Knee Arthroplasty: A Retrospective Analysis Using Medicare Claims
ConclusionsRace was not associated with administration of regional anesthesia in Medicare patients undergoing primary total knee arthroplasty. Variation in the use of regional anesthesia was primarily associated with the hospital where surgery occurred.Editor ’s PerspectiveWhat We Already Know about This TopicRegional analgesia for management of postoperative pain after total knee arthroplasty is recommended by numerous relevant societiesBlack patients undergoing total knee arthroplasty have worse outcomes compared to White patientsPrevious analyses of postoperative analgesia management among commercially insured patient...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
Effect of Extracerebral Contamination on Near-infrared Spectroscopy as Revealed during Organ Donation: A Prospective Observational Study in Brain-dead Organ Donors
ConclusionsThe abrupt end of extracerebral contamination, caused by aortic clamping, affected both NIRS monitors to a considerable extent. Both the INVOS and the ForeSight monitor were unable to detect severe cerebral hypoxia or anoxia under conditions of normal extracerebral oxygenation. While both NIRS monitors may guide measures to optimize arterial oxygen supply to the head, they should not be used with the intention to detect isolated cerebral desaturations.Editor ’s PerspectiveWhat We Already Know about This TopicNear-infrared spectroscopy is commonly used as a clinical measure of cerebral perfusion and oxygenation...
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
ASA Consensus-based Guidance on Preoperative Management of Patients on Glucagon-like Peptide-1 Receptor Agonists
(Source: Anesthesiology)
Source: Anesthesiology - January 16, 2024 Category: Anesthesiology Source Type: research
