Abstract: The determination of intravascular volume in haemodynamically unstable patients is key to subsequent management. Administration of fluid remains the cornerstone of treatment but fluid loading in those patients not responsive to fluid is detrimental to outcome, as interstitial oedema impedes tissue oxygenation. Traditionally, static markers of cardiac preload such as central venous pressure have guided fluid therapy. Such markers have been shown to poorly predict fluid responsiveness. This has led to increased interest in dynamic variables such as the fluctuation of blood pressure and stroke volume in response to mechanical ventilation. These variables use the cyclical changes induced by positive pressure ventilation on right and left ventricular loading to measure changes in left ventricular stroke volume and arterial pressure. These dynamic indices, termed systolic pressure variation, pulse pressure variation and stroke volume variation, are superior in predicting fluid responsiveness in mechanically ventilated patients with a regular cardiac rhythm. In patients with spontaneous respiratory effort, the response of stroke volume to a passive leg raise is also an accurate indicator of fluid status.
Publication date: Available online 8 October 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Valent, Benjamin Maïer, Russell Chabanne, Vincent Degos, Bertrand Lapergue, Anne-Claire Lukaszewicz, Mikael Mazighi, Etienne Gayat
Conclusions: Carotid endarterectomy continues to prove its safety in carotid artery stenosis patients. Continuous cerebral oxygenation monitoring is indispensable for carotid surgery. Despite discrepancies in surgical techniques, we believe that "one fits all strategy: general anesthesia, conventional endarterectomy without patch plasty, never shunter and always NIRS monitorization" may be used safely in patients undergoing carotid endarterectomy. PMID: 33014089 [PubMed]
In this study, the authors sought to analyze and compare patients ≥ 65 years old with those
Background and Purpose: Intracranial atherosclerotic disease (ICAD) is a common cause of stroke worldwide. Although there are different endovascular options for the treatment of symptomatic ICAD (sICAD), it is still controversial. Herein, we aim to study the safety and efficacy of a new generation of drug-eluting balloon-mounted stent (DES); Resolute (R) onyx DES in the treatment of sICAD.Methods: A prospectively maintained neuroendovascular procedures database in a high-volume comprehensive stroke center was reviewed from October 2019 through January 2020. Patients were included if they had sICAD (≥70% stenosis), faile...
Malignant hyperthermia (MH) and Exertional Heat Stroke (EHS) present hypermetabolic states leading to rhabdomyolysis and muscle rigidity with progressive hyperthermia; MH is triggered by volatile inhaled anesthetics, while EHS is triggered by exercise in hot/humid environment. Given the similarity of clinical features and the fact that a portion of EHS cases were diagnosed as MH susceptible by the in vitro contracture test, MH and EHS are believed to share common etiology. Mutations in RYR1 and CACNA1S have been found to be associated with MH; however the genetic cause remains to be identified in approximately 30% of MH cases.
In conclusion, SZV-270 with its combined Class I/B and III effects can prevent re-entry arrhythmias with reduced risk of provoking drug-induced Torsades de Pointes. PMID: 32970956 [PubMed - as supplied by publisher]
Conclusions: Both TED and FloTrac devices can be used effectively to guide GDFT in RT, However, lesser total fluid was required in the FloTrac group, which may lead to a lesser number of fluid-related postoperative complications.
Propofol protects against oxygen/glucose deprivation‑induced cell injury via gap junction inhibition in astrocytes. Mol Med Rep. 2020 Jul 28;: Authors: Fan Y, Zhu S, Wang J, Zhao Y, Wang X Abstract Stroke is one of the leading causes of mortality and disability worldwide with limited clinical therapies available. The present study isolated primary astrocytes from the brains of rats and treated them with oxygen‑glucose deprivation and re‑oxygenation (OGD/R) to mimic hypoxia/reperfusion (H/R) injury in vitro to investigate stroke. It was revealed that propofol (2,6‑diisopropylphenol), an int...
ConclusionThe use of CEA is a feasible alternative to CAS in acute stroke and has the advantage that DAPT/GpIIb/IIIa inhibitors are not needed. All PH2 in CEA patients occurred during the intervention, implying that hemorrhage in this group is likely to be caused by reperfusion injury, whereas delayed hemorrhage is likely to b e caused by DAPT/GpIIb/IIIa inhibitors.
Abstract Acute ischemic stroke is a neurological emergency with a high likelihood of morbidity, mortality, and long-term disability. Modern stroke care involves multidisciplinary management by neurologists, radiologists, neurosurgeons, and anesthesiologists. Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend thrombolytic therapy with intravenous (IV) alteplase within the first 3-4.5 hours of initial stroke symptoms and endovascular mechanical thrombectomy within the first 16-24 hours depending on specific inclusion criteria. The anesthesia and critical care provider may b...