A practical approach to cerebral Near Infrared Spectroscopy (NIRS) directed hemodynamic management in non-cardiac pediatric anesthesia.

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Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research

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Advances in imaging and technique have pushed the boundaries of the types of surgical interventions available to fetuses with congenital and developmental abnormalities. This review focuses on fundamental aspects of fetal anesthesia, including the physiologic changes of pregnancy, uteroplacental perfusion, and fetal physiology. We discuss the types of fetal surgeries and procedures currently being performed and discuss the specific anesthetic approaches to different categories of fetal surgeries. We also discuss ethical aspects of fetal surgery and anesthesia.
Source: Clinics in Perinatology - Category: Perinatology & Neonatology Authors: Source Type: research
Abstract BACKGROUND: Extracorporeal shock wave therapy (ESWT) has shown benefits in patients with nonunion or delayed bone healing, pseudarthrosis, and avascular necrosis of bone. Until now, these effects were explained by the release of growth factors, activation of cells, and microfractures occurring after ESWT. Microcirculation is an important factor in bone healing and may be compromised in fractured scaphoids because its blood supply comes from the distal end. Due to this perfusion pattern, the scaphoid bone is prone to nonunion after fracture. The ability of ESWT to enhance microcirculation parameters in sof...
Source: Clinical Orthopaedics and Related Research - Category: Orthopaedics Authors: Tags: Clin Orthop Relat Res Source Type: research
Publication date: Available online 24 September 2019Source: Saudi Journal of Biological SciencesAuthor(s): Qinghong Song, Yan ZhangAbstractIn order to study the construction of digital three-dimensional model of rabbit vascular network and provide a powerful basis for the model construction and image processing of human vascular network, in this study, rabbit abdominal and pelvic vessels are perfused with latex-bismuth oxide contrast agent. After that, the internal fibrous structure of the abdominal and pelvic vascular network in rabbits is studied by micro-computed tomography (Micro-CT). Angiography and post-processing so...
Source: Saudi Journal of Biological Sciences - Category: Biology Source Type: research
AbstractPerioperative goal-directed hemodynamic therapy (GDHT) has evolved from invasive “supra-physiological” maximization of oxygen delivery to minimally or even noninvasively guided automated stroke volume optimization. Over the past four decades, investigators have simultaneously developed novel monitors, updated strategies, and automated technologies to improve GDHT. Decision s upport technology, which proposes an intervention based on the patient’s real time physiologic status, was an important step towards automation. Closed-loop systems have now been created to both increase GDHT compliance and de...
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
THE LUNGS and heart can be visualized as closely related neighbors, with any intervention or disease of one intricately affecting the other. Despite refinements in the perfusion, surgical, and anesthetic regimens, lung injury after cardiac surgery continues to pose a formidable diagnostic and management challenge.1 A multitude of factors, such as median sternotomy, cardiopulmonary bypass (CPB) and associated inflammatory response, blood transfusion, capillary injury, mechanical ventilation and, cardiopulmonary interactions contribute to lung injury after cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
Extracorporeal cardiopulmonary resuscitation involves the application of venoarterial extracorporeal membrane oxygenation for patients in cardiac arrest who have received good quality conventional cardiopulmonary resuscitation, and who are deemed to have a reversible cause and no contraindications. Systemic perfusion is maintained by the extracorporeal life support, allowing time for the underlying cause to be treated and the heart to recover. Specific considerations to promote cardiac recovery are discussed, including the maintenance of sinus rhythm, promotion of cardiac ejection, management of pulmonary hypertension, man...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research
Publication date: Available online 12 September 2019Source: Journal of Critical CareAuthor(s): M.-H. Ho Anthony, Glenio B. MizubutiAbstractProphylactic administration of a vasopressor to mitigate the hypotensive effect of propofol (and/or other co-induction agents) during sedation/anesthesia immediately prior to tracheal intubation in frail patients in the intensive care unit and emergency and operating rooms appears to be not an uncommon practice. We submit that this practice is unnecessary and potentially harmful. Despite restoring the blood pressure, phenylephrine, for instance, may have an additive or synergistic effec...
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research
Microcirculation is a system composed of interconnected microvessels, which is responsible for the distribution of oxygenated blood among and within organs according to regional metabolic demand. Critical medical conditions, e. g., sepsis, and heart failure are known triggers of microcirculatory disturbance, which usually develops early in such clinical pictures and represents an independent risk factor for mortality. Therefore, hemodynamic resuscitation aiming at restoring microcirculatory perfusion is of paramount importance.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research
We examined the usefulness of a noninvasive electrical velocimetry (EV) device based on the thoracic bioimpedance method for perioperative hemodynamic monitoring in patients after aneurysmal subarachnoid hemorrhage. Patients and Methods: In total, 18 patients who underwent surgical clipping or endovascular coiling for ruptured aneurysms were examined prospectively. Simultaneous cardiac index (CI) measurements obtained with EV (CIEV) and reference transpulmonary thermodilution (CITPTD) were compared. A total of 223 pairs of data were collected. Results: A significant correlation was found between CIEV and CITPTD (r=0.86; P
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Clinical Reports Source Type: research
Ankur Khandelwal, Parmod Kumar Bithal, Girija Prasad RathJournal of Anaesthesiology Clinical Pharmacology 2019 35(3):302-311 Patients with severe traumatic brain injury often presents with extracranial injuries, which may contribute to fatal outcome. Anesthetic management of such polytrauma patients is extremely challenging that includes prioritizing the organ system to be dealt first, reducing on-going injury, and preventing secondary injuries. Neuroprotective and neurorescue measures should be instituted simultaneously during extracranial surgeries. Selection of anesthetic drugs that minimally interferes with cerebral d...
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
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