Capillary dynamics and the interstitial fluid –lymphatic system
Publication date: Available online 8 May 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Marina Sawdon, Emrys Kirkman The capillaries are the ‘business end’ of the circulatory system, where materials exchange between the plasma and tissues. Water-soluble molecules can diffuse through pores in the capillaries, and a Gibbs–Donnan equilibrium exists between the plasma and interstitium. There are several types of capillaries, which vary in their anatomical integrity and permeability. There is also a bulk flow of fluids between the plasma and interstitium, described by the Starling forces. Originally, these forces were thought to cause fluids to leave the capillaries at the arteriolar end and return at the venular end; the role of the lymphatics was to provide an ‘overflow’ mechanism due to protein leakage out of the capillaries. More recent work indicates that this concept needs modification. Lymph flow and interstitial colloidal osmotic pressure are now known to be greater than first thought, and the interstitium has a slightly negative hydrostatic pressure. It is now believed that filtration takes place along most of the capillary, and the lymphatic system plays a more important role in maintaining plasma–interstitium equilibrium and preventing oedema. The system acts as a ‘closed’ one in that the changes in fluid formation (e.g. following haemorrhage or cardiac failure) are self-limiting. However, in s...
ConclusionUltrasound guided infiltration allows accurate placement of large volume of diluted local anaesthetic solution safely and provides effective anaesthesia.
ConclusionA multimodal oral analgesia protocol provides sufficient pain relief to allow closed reduction of upper-limb fractures in children at the emergency department. This management strategy provided high satisfaction rates in both the patients and their parents.Level of evidenceII, prospective observational study.
Pressure injuries (PIs) are a common yet challenging problem especially in people with spinal cord injury (SCI) because of immobility and anesthetic skin. They are difficult to treat with standard medical care and often recur. Recent interest in the treatment of chronic wounds like PIs has shifted from the type of dressing with or without pharmaceutical topical agents to different therapies like negative pressure wound therapy (NPWT), gene therapy and stem cell based therapies. The rationale behind the use of cell-based therapies is the fact that cells in chronic wounds are phenotypically altered or senescent or both.
This study sought to assess the operability of TELD at the L5-S1 disc level.
Spinal anesthesia (SA) has been shown in several studies to be a viable alternative to general anesthesia (GA) in laminectomies and discectomies. However, very few spine surgeons have extended the use of SA to lumbar fusion surgery, and few studies have documented its use in the literature. The authors posit that SA may lead to lower postoperative pain than GA, and thus have implemented use of a novel thoracolumbar interfascial plane (TLIP) block for additional long-lasting analgesia.
Spinal anesthesia (SA) has been shown in several studies to be a viable alternative to general anesthesia (GA) in laminectomies, discectomies and microdiscectomies. However, the use of SA in spinal fusion surgery has been very scarcely documented in the current literature. Here we present a comparison of SA to GA in lumbar fusion surgery in terms of perioperative outcomes and cost.
An increasing focus on value-based care in elective spine surgery has prompted interest in alternative modalities of surgical intervention. Avoidance of general anesthesia (GA) is one modality that has recently gained support due to reductions in postoperative symptoms related to general anesthetics. Some patients with operative spine pathology cannot tolerate a GA due to comorbidities or other issues that preclude RA or GA. Our goal was to determine the complication rate of lumbar spinal decompression under local anesthesia with IV sedation (LIS) compared to patients decompressed under general anesthesia.
This meta-analysis aimed to determine the optimal effective dosage and delivery method of tranexamic acid in cardiac surgery.BMC Anesthesiology
This study aimed to investigate the factors affecting the postoperative mortality rate in patients undergoing surgery for perforated diverticulitis. Further, we compared the recovery courses of patients between open and laparoscopic surgeries. Methods: We analyzed the medical records of adult patients with peritonitis caused by perforated diverticulitis from six hospitals of Hallym University Medical Center from January 2006 to December 2016. Results: A total of 166 patients were identified. In the univariate analysis, the statistically significant factors associated with postoperative mortality were age ≥ 60 ye...
Conclusions: A single preoperative dose of i.v. dexamethasone reduces PONV in children undergoing elective UGIE with deep sedation, but has no significant effect on the patient recovery time or the incidence of postoperative bronchospasm or laryngospasm and emergence delirium.