An Open Label Pilot Study of a Dexmedetomidine ‐Remifentanil‐Caudal Anesthetic for Infant Lower Abdominal/Lower Extremity Surgery: The T REX Pilot Study

AbstractBackgroundConcern over potential neurotoxicity of anesthetics has led to growing interest in prospective clinical trials using potentially less toxic anesthetic regimens, especially for prolonged anesthesia in infants. Preclinical studies suggest that dexmedetomidine may have a reduced neurotoxic profile compared to other conventional anesthetic regimens; however, coadministration with either anesthetic drugs (e.g. remifentanil) and/or regional blockade is required to achieve adequate anesthesia for surgery. The feasibility of this pharmacological approach is unknown. The aim of this study was to determine the feasibility of a remifentanil/dexmedetomidine/ neuraxial block technique in infants scheduled for surgery lasting longer than 2 hours.MethodsSixty infants (age 1 ‐12 months) were enrolled at seven centers over 18 months. A caudal local anesthetic block was placed after induction of anesthesia with sevoflurane. Next, an infusion of dexmedetomidine and remifentanil commenced, and the sevoflurane was discontinued. Three different protocols with escalating dos es of dexmedetomidine and remifentanil were used.ResultsOne infant was excluded due to a protocol violation and consent was withdrawn prior to anesthesia in another. The caudal block was unsuccessful in 2 infants. Of the 56 infants who completed the protocol 45 (80%) had at least one episode of hypertension (Mean Arterial Pressure>80 mmHg) and/or movement that required adjusting the anesthesia regimen. In...
Source: Pediatric Anesthesia - Category: Anesthesiology Authors: Tags: Research Report Source Type: research

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Conclusions6 β-OHT is required for the action of Ang II to increase vascular reactivity and cause endothelial dysfunction, hypertrophy, and increase in oxygen radical production. The effect of 6β-OHT in mediating Ang II-induced hypertension and associated hypertrophy is dependent on the androgen receptor. Ther efore, CYP1B1 could serve as a novel target for the development of therapeutics to treat vascular changes in hypertensive males.
Source: Biology of Sex Differences - Category: Biology Source Type: research
In the May 2019 issue, the article “Perioperative Fluid Therapy for Major Surgery” (Miller TE, Myles PS: Anesthesiology 2019; 130:825 –32. doi: 10.1097/ALN.0000000000002603) contains an error. In the following sentence on page 828, “If a patient is volume-optimized (not fluid responsive) and remains hypotensive (mean blood pressure greater than 65mm Hg and possibly higher in patients with preexisting hypertension), a vasopress or infusion should be considered,” the words “greater than” should be “less than.” The full, corrected sentence reads: “If a patient is vol...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
In this study, we aimed to investigate the effect of the severity of ...
Source: BMC Cardiovascular Disorders - Category: Cardiology Authors: Tags: Research article Source Type: research
TAKAYASU'S ARTERITIS (TA) is a rare clinical condition, with an incidence of 1 to 2 cases per million in Japan.1 It is characterized by chronic panarteritis of the aorta and its primary branches, including the subclavian, common carotid, coronary, and renal arteries, and may result in localized stenosis, vascular occlusion, dilatation, and aneurysm formation.2 The disease can cause various circulatory complications, such as hypertension, heart failure, aortic regurgitation, coronary stenosis, and aortic aneurysm.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Report Source Type: research
Abstract BACKGROUND: Postoperative blood product transfusions in elderly hip fracture patients cause concern for morbidity and mortality. The purpose of this study was to identify predictors and short-term sequelae of postoperative transfusion following geriatric hip fracture surgery. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to identify geriatric (⩾65 years) patients who sustained operative femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Multivariate regression was used to determine risk-adjusted odds ra...
Source: Hip International - Category: Orthopaedics Authors: Tags: Hip Int Source Type: research
ConclusionInterventional paediatric catheterisation has grown remarkably in Morocco. These procedures have become the treatment of choice for many cardiac lesions, and serve as alternatives or adjuncts to surgical treatment.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
We report a case of postoperative PRES in a 12-year-old previously normotensive child posted for splenectomy with an acute rise in blood pressure in the post-operative period.
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
AbstractIntroduction and hypothesisPelvic floor disorders are common among and disproportionately affect older women. There are limited data regarding perioperative adverse events in older women undergoing robot-assisted sacrocolpopexy (RASC) specifically. The aim of this study was to compare the rate of perioperative adverse events in younger (age  65  years) women who underwent RASC.MethodsWe conducted a retrospective cohort study of women who underwent RASC between 2013 and 2018. Postoperative adverse events were categorized according to the Clavien –Dindo classification. Our primary outcome was the ra...
Source: International Urogynecology Journal - Category: OBGYN Source Type: research
J Knee Surg DOI: 10.1055/s-0039-3402803While prior studies have demonstrated that insulin-dependence is an independent risk factor for postoperative complications, morbidity, and mortality following spine and shoulder, hip, and knee arthroplasty, it has not been evaluated in the setting of knee arthroscopy. Therefore, the purpose of this study is to compare the risk of postoperative complications among patients with insulin-dependent diabetes mellitus and noninsulin-dependent diabetes mellitus (IDDM and NIDDM respectively) with the general population following knee arthroscopy. A retrospective analysis of the National Surg...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
We describe a child with ASD and limited dietary options leading to undiagnosed scurvy and intraoperative hypotension.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports Source Type: research
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