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 12 December 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Christopher J. TaylorAbstractIntracerebral haemorrhage (ICH) accounts for around 10–20% of all strokes and results from a variety of disorders. ICH is more likely to result in death or major disability than ischaemic stroke or subarachnoid haemorrhage. Rapid imaging allows early diagnosis and characterization of the localization and severity of the haemorrhage. Patients with significant acute ICH should be managed in a critical care unit. Treatment entails general supportive care, control of blood pressure an...
Conclusions Preoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomes. However, there was a significant association between vitamin D deficiency and a composite of infectious complications and decreased kidney function. While renal effects were not clinically meaningful, the effect of vitamin D supplementation on infectious complications requires further study.
Conclusion: During anesthesia, in preload independent patients, ARMs through CPAP resulted in a significantly greater decrease in SV than stepwise increase in PEEP. During anesthesia, ARM should be used cautiously.
Conclusion: The IIT did not improve the morbidity and mortality in our patients undergoing coronary artery bypass grafting.
Conclusions: It was feasible to randomize AIS patients receiving either general anesthesia or conscious sedation for EVT.
AbstractPurpose of reviewEndovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke.Recent findingsThe indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6 –24 h after last-known-well, and improved device and operator proficiency allowi...
Conclusion: In patients with low EF <35% and CHF, administration of levosimendan for 24 hours before major abdominal oncologic surgeries may reduce the risk of hypotension and decompensated heart failure and may improve cardiac function.
Abstract Intracerebral hemorrhage (ICH) is a devastating stroke often modelled in rats. Isoflurane anesthetic, commonly used in preclinical research, affects general physiology (e.g., blood pressure) and electrophysiology (e.g., burst suppression) in many ways. These physiological changes may detract from the clinical relevance of the model. Here, we revised the standard collagenase model to produce an ICH in rats without anesthetic. Guide cannulas were implanted stereotaxically under anesthetic. After 3 days of recovery, collagenase was infused through an internal cannula into the striatum of animals randomly ass...
ISCHEMIC stroke in children is very rare, with a reported incidence of 2 to 13 cases per 100,000 children.1 Tumors, endocarditis, vasculopathy, thrombotic disorders, and inflammatory disorders are the usual causes of an ischemic stroke in children.2,3 Transient cutaneous eruptions involving the extremities often precede the onset of neurologic symptoms in children with cardiac myxomas.4 Very few cases of ischemic stroke resulting from myxoma in children younger than 18 years have been reported in the literature.
ConclusionBaseline cut off thrombus appearance predicts a higher number of thrombectomy maneuvers. In day to day practice this may prepare the neurointerventionalist for a more challenging endovascular procedure ahead. Stroke etiology, clinical outcomes and thrombus-specific characteristics did not show any associations with the thrombus appearance.