I ’m sorry about what happened to your son under anesthesia

It was a sunny morning in July, and I was scheduled at the outpatient center with the oral and maxillofacial surgeons for teeth extractions. One of my patients was your son, an athletic teenager, whose only medical history was asthma. According to you and him, he had not experienced any recent asthma attacks and had never been hospitalized or intubated. In terms of breathing, he said he felt “perfectly fine” for many years. The last time he took his inhaler was yesterday prior to exercising. He had not experienced any upper respiratory infections recently and was not having any difficulty breathing today. I placed my stethoscope on his chest and heard clear breath sounds. Reassured, I proceeded to finish setting up the operating room. Confession: there are many risks and side effects of anesthesia, and we don’t always mention all of them — especially to the young, healthy patients that come for same-day surgery. The most common risks are a sore throat (from the endotracheal tube), nausea and vomiting (from the anesthetic medications and the nature of certain surgeries) and short-term memory loss (also from the anesthetic agents). The major ones are very rare and include bronchospasm (when your airways close), heart attack, stroke, severe allergic reactions leading to cardiovascular collapse and subsequently — death. I spoke to you about the common risks and mentioned your son’s slightly higher risk of an asthma exacerbation under anesthesia...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Surgery Source Type: blogs

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Background Diabetes mellitus predicts poorer outcomes in patients with acute coronary syndrome (ACS), but the magnitude of this association in patients at older ages remains controversial. Methods Data were extracted from the Codi Infart database. All consecutive patients with diagnosis of ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) between 2010 and 2015 were included. We assessed the impact of diabetes mellitus on 30-day and one-year mortality in patients aged less than and at least 75 years. Results A total of 12 792 cases were registered, of whom...
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
This study was performed to evaluate the relationship between the CHA2DS2-VASc score and no-reflow (NR) phenomena in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total number of 428 consecutive patients with NSTEMI were assessed for this study. Patients were divided into 2 groups, those with NR, NR(+) (n=84), and those without NR, NR(-) (n=307), according to their post-PCI, no-reflow status. The CHA2DS2-VASc score was significantly higher in the NR(+) group compared to the NR(-) (3.48 ± 1.19 vs 1.81 ± 0.82, P
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
Conclusion was associated a higher possibility of post-PCI acute kidney injury and did not seem to improve 30-day or 1-year clinical outcomes. Patients undergoing staged CR during the same hospitalization had better clinical outcomes.
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
Conclusion The best algorithm to localise the culprit artery includes ST-elevation in leads II and V6 related to Cx, and ST-elevation in leads III, aVF and V3 related to right coronary artery. Our algorithm has been validated internally and externally, and works better than other previously published algorithms.
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
Conclusion: Sirolimus-eluting Stentys stent may represent a potential solution for specific coronary anatomies such as bifurcation, ectasic, or tapered vessels. Risk of stent thrombosis appears related to clinical presentation with STEMI and to anatomic features, stressing the importance of the use of intracoronary imaging for self-expandable stents implantation.
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
Conclusions DCB angioplasty for de novo small coronary lesions in the real-world environment in Japan is effective with acceptable 12-month outcomes.
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
We examined the proportions of use of TRA, the influence on in-hospital outcomes, and adjusted long-term effects. Results The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions, and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA versus transfemoral artery (1.8 vs. 5.1%, overall, P 
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
Background We hypothesized that the transition from bare-metal stents (BMS) to newer generation drug-eluting stents (n-DES) in clinical practice may have reduced the risk also in patients with kidney dysfunction. Methods: Observational study in the national SWEDEHEART registry, that compared the 1-year risk of in-stent restenosis (RS) and stent thrombosis (ST) in all percutaneous coronary intervention treated patients(n = 92 994) during 2007–2013. Results: N-DES patients were younger than BMS, but had more often diabetes, previous myocardial infarction, previous revascularization and were more often treated w...
Source: Coronary Artery Disease - Category: Cardiology Tags: Myocardial Infarction/Cardiogenic Shock Source Type: research
Conclusion Compared with heparin plus GPI or bivalirudin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding at 30 days among patients with NSTE-ACS and positive biomarkers.
Source: Coronary Artery Disease - Category: Cardiology Tags: Adjunctive Pharmacology Source Type: research
Background Visual–functional mismatch between coronary angiography and fractional flow reserve (FFR) has been reported, and the underlying reason remains poorly understood. Therefore, the relationship between angiographic measurements and FFR was evaluated, and predictors for FFR in intermediate coronary artery stenosis were determined. Methods Consecutive 314 patients (405 lesions) with a lesion of 30–80% angiographic diameter stenosis who underwent invasive FFR were recruited. The myocardial area supplied by the coronary artery distal to the stenosis was evaluated using a modified version of the Bypass A...
Source: Coronary Artery Disease - Category: Cardiology Tags: Coronary Physiology Source Type: research
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