Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System A Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery
Background The type of fluid and volume regimen given intraoperatively both can impact patient outcome after major surgery. This two-arm, parallel, randomized controlled, double-blind, bi-center superiority study tested the hypothesis that when using closed-loop assisted goal-directed fluid therapy, balanced colloids are associated with fewer postoperative complications compared to balanced crystalloids in patients having major elective abdominal surgery.Methods One hundred and sixty patients were enrolled in the protocol. All patients had maintenance-balanced crystalloid administration of 3 ml · kg–1· h–1. A closed-loop system delivered additional 100-ml fluid boluses (patients were randomized to receive either a balanced-crystalloid or colloid solution) according to a predefined goal-directed strategy, using a stroke volume and stroke volume variation monitor. All patients were included in the analysis. The primary outcome was the Post-Operative Morbidity Survey score, a nine-domain scale, at day 2 postsurgery. Secondary outcomes included all postoperative complications.Results Patients randomized in the colloid group had a lower Post-Operative Morbidity Survey score (median [interquartile range] of 2 [1 to 3]vs. 3 [1 to 4], difference –1 [95% CI, –1 to 0];P
CONCLUSIONS: Patients at higher risk of stroke frequently underestimate their risk of perioperative stroke. The majority of patients had not discussed perioperative stroke prior to anesthetic consultation. PMID: 31531829 [PubMed - as supplied by publisher]
ConclusionsThe incidence of PSE after mechanical thrombectomy was low in our cohort. All blood biomarkers displayed interesting sensitivity and specificity. However, the number of PSE cases was small and more studies are needed on risk factors for PSE after mechanical thrombectomy. The potential of blood markers of brain injury markers to contribute to assessment of PSE risk should be explored further.This article is part of the Special Issue "Seizures &Stroke".
CONCLUSIONS: The incidence of PSE after mechanical thrombectomy was low in our cohort. All blood biomarkers displayed interesting sensitivity and specificity. However, the number of PSE cases was small and more studies are needed on risk factors for PSE after mechanical thrombectomy. The potential of blood markers of brain injury markers to contribute to assessment of PSE risk should be explored further. This article is part of the Special Issue "Seizures &Stroke". PMID: 31526644 [PubMed - as supplied by publisher]
In this study, propofol administration significantly reduced the neurotoxic aggregation of α-synuclein, decreased the infarct area, and attenuated the neurological deficits after ischemic stroke in a mouse model. We then demo nstrated that the propofol-induced reduction of α-synuclein aggregation was associated with increased mammalian target of rapamycin/ribosomal protein S6 kinase beta-1 signaling pathway activity and reduction of the excessive autophagy occurring after acute ischemic stroke.
Publication date: Available online 6 September 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Rhian P. Lewis, Indre KriukelyteAbstractIn this article we discuss complex neuropathic pain states: diabetic peripheral neuropathic pain (DPNP), phantom limb pain (PLP), central post-stroke pain (CPSP), and complex regional pain syndrome (CRPS). Pain in these conditions can often be severe, significantly affect quality of life and be resistant to current treatment options. Multidisciplinary assessment and treatment is essential.
The objective of this review is to identify outstanding topics most relevant to neuroanesthesia practice and patient outcomes. We discuss the role of awake craniotomy, choice of general anesthetic agents, monitoring of anesthetic ‘depth’, mannitol-induced diuresis, neurophysiological monitoring, hyperventilation, and cerebral hypoperfusion. Recent findings Awake craniotomy, although a technique likely underused, is associated with enhanced recovery after surgery and prolonged survival after brain tumor resection compared with surgery under general anesthesia. The choice of general anesthetic must balance pat...
Purpose of review Stroke is the second leading cause of death and the third leading cause of disability worldwide. Treatment is time limited and delays cost lives. This review discusses modern stroke management, during a time when treatments and guidelines are rapidly evolving. Recent findings Stroke thrombectomy has become the therapy of choice for large vessel occlusion (LVO) strokes. Perfusion imaging techniques, both computed tomography (CT) and MRI, now allow treatment beyond a set time window in specific patients. Both general anaesthesia and conscious sedation are options for patients undergoing stroke thrombec...
Conclusions. The elevated baseline CVP, elevated baseline RVEDV after anesthesia induction, and decreased SvO2 during anhepatic phase were associated with postoperative AKI. Prospective trials are required to evaluate whether the optimization of these variables may decrease the risk of AKI after LDLT.
UP TO 40% of all ischemic strokes are considered cryptogenic, implying a stroke without a definitive etiology.1,2 With a dearth of evidence-guided treatment strategies, the literature surrounding cryptogenic stroke is highly variable and not well-standardized. Even though existing guidelines do not specify the exact testing required, the cryptogenic stroke evaluation includes a variety of imaging modalities (eg, echocardiography, angiography, magnetic resonance imaging, carotid ultrasound) and laboratory investigations (eg, genetic testing, hypercoagulable disorder panels, erythrocyte sedimentation rate).
(BMJ. 2018;363:k4109) Vascular dysfunction plays an important role in the pathophysiology of preeclampsia, and women with a history of preeclampsia face an increased risk of other cardiovascular disorders after pregnancy, including hypertension and stroke. Given these associations, women with preeclampsia might also be at increased risk of developing dementia. Previous studies that have investigated the association between hypertensive disorders of pregnancy and dementia later in life have had limitations such as being underpowered and dependent on self-reported information. This current study used a large register-based ...