Effects of propofol on ischemia-reperfusion and traumatic brain injury

Publication date: Available online 24 December 2019Source: Journal of Critical CareAuthor(s): Melissa A. Hausburg, Kaysie L. Banton, Phillip E. Roman, Fernando Salgado, Peter Baek, Michael J. Waxman, Allen Tanner, Jeffery Yoder, David Bar-OrAbstractOxidative stress exacerbates brain damage following ischemia-reperfusion and traumatic brain injury (TBI). Management of TBI and critically ill patients commonly involves use of propofol, a sedation medication that acts as a general anesthetic with inherent antioxidant properties. Here we review available evidence from animal model systems and clinical studies that propofol protects against ischemia-reperfusion injury. However, evidence of propofol toxicity in humans exists and manifests as a rare complication, “propofol infusion syndrome” (PRIS). Evidence in animal models suggests that brain injury induces expression of the p75 neurotrophin receptor (p75NTR), which is associated with proapoptotic signaling. p75NTR-mediated apoptosis of neurons is further exacerbated by propofol's superinduction of p75NTR and concomitant inhibition of neurotrophin processing. Propofol is toxic to neurons but not astrocytes, a type of glial cell. Evidence suggests that propofol protects astrocytes from oxidative stress and stimulates astroglial-mediated protection of neurons. One may speculate that in brain injury patients under sedation/anesthesia, propofol provides brain-tissue protection or aids in recovery by enhancing astrocyte func...
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research

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CONCLUSIONS: The CARD cognitive aid did not significantly improve time-based or clinical maternal and neonatal outcomes of emergency Cesarean delivery at our academic maternity unit. PMID: 32415478 [PubMed - as supplied by publisher]
Source: Canadian Journal of Anaesthesia - Category: Anesthesiology Authors: Tags: Can J Anaesth Source Type: research
This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. MATERIAL AND METHODS: This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based imple...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
CONCLUSIONS: In simulated critical events, anesthesia residents and student nurse anesthetists often consulted a cognitive aid only after first performing at least some key behaviors. Incorporating the possibility of delayed access into critical event cognitive aid design may facilitate the effectiveness of that aid. PMID: 32271972 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
Purpose of review Patient decision aids are educational tools used to assist patients and clinicians in healthcare decisions. As healthcare moves toward patient-centered care, these tools can provide support to anesthesiologists by facilitating shared decision-making. Recent findings Recent research has shown that patient decision aids are beneficial in the clinical setting for patients and physicians. Studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression, and decisional conflict after using patient decision aids. In addition, a structured approach for the deve...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle Source Type: research
CONCLUSIONS: We did not find sufficient evidence to draw firm conclusions as to the best interventions to increase acceptance of LA in children due to variation in methodology and nature/timing of outcome measures. We recommend further parallel RCTs, reported in line with the CONSORT Statement. Care should be taken when choosing outcome measures. PMID: 32104910 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Publication date: Available online 21 February 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Meffert, Dimitri Baudrier, Dan Benhamou, Laurent Mattatia, Antonia Blanié
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Condition:   Decision Making, Shared Intervention:   Other: Shared decision making with the used of patient decision aids Sponsors:   Taipei Medical University Shuang Ho Hospital;   Chi Mei Medical Hospital Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Ramya Ravi, Muthapillai Senthilnathan, Ranjith K Sivakumar, Chanjeeviram SuganthapriyaIndian Journal of Anaesthesia 2020 64(2):145-147 Capnography and end tidal CO2 (EtCO2) aids the anaesthesiologist in diagnosing problems during all phases of general anaesthesia. Negative arterial to end-tidal carbon-dioxide gradient during anaesthesia has been reported in various conditions including pregnancy, infants and inadvertent exogenous addition of carbon dioxide (CO2) to the expired gas in case of thoracoscopic procedures with iatrogenic injury to lung parenchyma/bronchial tree. Thus, airway injury or intentional opening of air...
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
CONCLUSIONS: The American Society of PeriAnesthesia Nurses guideline is applicable for preventing hypothermia under general anesthesia, which, in turn, aids in patient recovery through the suppression of various hypothermia-related complications. PMID: 32005604 [PubMed - as supplied by publisher]
Source: Journal of Perianesthesia Nursing - Category: Nursing Authors: Tags: J Perianesth Nurs Source Type: research
Abstract Four basic types of visual aids are used for teaching airway management and decision-making in simulated as well as in real clinical situations: universal algorithms, sets of limited algorithms, concept-based cognitive aids and checklists. The first three may represent an evolution in the understanding of the role of human error in both successful and failed airway management. Complex visual aids such as the American Society of Anesthesiology difficult airway algorithm may be more useful for teaching, while graphic cognitive aids like the Vortex may be more helpful for decision-making under stress. Not su...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
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