Hypovolaemia

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.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Authors: Tags: CORE: Trauma Source Type: research

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In this study, we evaluated seven goats (body weight 44.5  ± 6.5 kg) with normal hearts. A centrifugal LVAD was implanted under general anesthesia. We inserted the conductance catheters into the left ventricle (LV) and right ventricle (RV) to assess the volume signal simultaneously. We defined the interventricular dyssynchrony as a signal (increase o r decrease) of LV volume (LVV) change opposite to that of RV volume (RVV) (i.e., (dLVV/dt)  × (dRVV/dt)  
Source: Journal of Artificial Organs - Category: Transplant Surgery Source Type: research
CONCLUSIONS: The transcarotid route for TAVI is reproducible and associated with low rates of adverse neurological events, access-related complications and bleeding complications. Routine use of locoregional anesthesia is feasible. Careful surgical management of the common carotid artery is pivotal. PMID: 31186217 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
This report details the case of a 63-year-old male experiencing a stroke in the immediate postoperative period after total knee arthroplasty. Risk for perioperative stroke is influenced by age, sex, ethnicity, comorbidities, and some medications. The depressed neurocognitive state of patients recovering from anesthesia warrants special consideration for the identification and management of perioperative stroke.
Source: Journal of PeriAnesthesia Nursing - Category: Nursing Authors: Tags: Continuing Education Source Type: research
CONCLUSIONS: Patients who underwent thrombectomy with conscious sedation in the extended time window experienced a higher likelihood of functional independence at 90 days, a lower NIHSS score at 24 hours, and a shorter time from femoral puncture to reperfusion compared with those who had general anesthesia. This effect remained robust in institutions that only treated patients with a single anesthesia technique.
Source: American Journal of Neuroradiology - Category: Radiology Authors: Tags: INTERVENTIONAL Source Type: research
AbstractBackgroundShort-acting vasopressor agents like phenylephrine or ephedrine can be used during carotid endarterectomy (CEA) to achieve adequate blood pressure (BP) to prevent periprocedural stroke by preserving the cerebral perfusion. Previous studies in healthy subjects showed that these vasopressors also affected the frontal lobe cerebral tissue oxygenation (rSO2) with a decrease after administration of phenylephrine. This decrease is unwarranted in patients with jeopardized cerebral perfusion, like CEA patients. The study aimed to evaluate the impact of both phenylephrine and ephedrine on the rSO2 during CEA.Metho...
Source: Neurocritical Care - Category: Neurology Source Type: research
Background: Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) are potential contributors to the success of revascularization. The aims of our study were to review the hemodynamic management by anesthesiologists and clinical outcomes in patients undergoing MT under conscious sedation. Methods: Retrospective cohort study of patients with anterior circulation AIS from January 2012 to March 2016. Primary outcome was hemodynamic intervention, defined as administration of vasoactive drugs to maintain systolic blood pressure (BP) between 140 and 180 mm&t...
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Clinical Investigations Source Type: research
A 60-YEAR-OLD, 88-kg, 165-cm woman presented to a community hospital with heart failure 5 years after mitral valve repair for mitral regurgitation. The patient previously suffered an ischemic stroke and was currently treated with dual antiplatelet therapy. Transesophageal echocardiography revealed severe mitral stenosis with a mean transmitral gradient of 10 mmHg and thickening of the posterior left atrial wall. The patient was then transferred to the authors ’ institution for mitral valve replacement.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Diagnostic Dilemma Source Type: research
Publication date: Available online 7 June 2019Source: NeuroImageAuthor(s): Julia V. Cramer, Benno Gesierich, Stefan Roth, Martin Dichgans, Marco Düring, Arthur LieszAbstractThe organization of brain areas in functionally connected networks, their dynamic changes, and perturbations in disease states are subject of extensive investigations. Research on functional networks in humans predominantly uses functional magnetic resonance imaging (fMRI). However, adopting fMRI and other functional imaging methods to mice, the most widely used model to study brain physiology and disease, poses major technical challenges and faces...
Source: NeuroImage - Category: Neuroscience Source Type: research
Boating, swimming, fishing and other water sports are popular summertime pursuits but can sometimes have the potential for danger. Here are some tips for dealing with injuries from water activities. Swimming problems. According to the American Orthopaedic Society for Sports Medicine, most swimming injuries involve the shoulders, back, hips or knees, depending on the individual's stroke. Treatment recommendations from the AOSSM include cutting back on repetitive strokes contributing to overuse, core-strengthening and cross-training exercises, rest periods, alternative training techniques (instead of train...
Source: Advanced Tissue - Category: Dermatology Authors: Tags: Wound Care Wound Infection Source Type: news
Obstructive sleep apnea (OSA) is a disorder characterized by breathing cessation caused by obstruction of the upper airway during sleep. It is associated with multiorgan comorbidities such as obesity, hypertension, heart failure, arrhythmias, diabetes mellitus, and stroke. Patients with OSA have an increased prevalence of ophthalmic disorders such as cataract, glaucoma, central serous retinopathy (detachment of retina, macular hole), eyelid laxity, keratoconus, and nonarteritic anterior ischemic optic neuropathy; and some might require surgery.
Source: Journal of Cataract and Refractive Surgery - Category: Opthalmology Authors: Tags: Review/update Source Type: research
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