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Cardiac Structure and Function in Morbidly Obese Parturients: An Echocardiographic Study.
CONCLUSIONS: Cardiac index did not differ between obese pregnant women and those with normal BMI. Their increased left ventricular mass and lower stroke volume index could indicate a limited adaptive reserve. Obese women had minor decreases in septal left ventricular tissue Doppler velocity, but the E/E' average values did not suggest clinically significant diastolic dysfunction. PMID: 29878938 [PubMed - as supplied by publisher]
Source: Anesthesia and Analgesia - June 5, 2018 Category: Anesthesiology Authors: Buddeberg BS, Fernandes NL, Vorster A, Cupido BJ, Lombard CJ, Swanevelder JL, Girard T, Dyer RA Tags: Anesth Analg Source Type: research

Fragmented Ambulance Services in Sri Lanka Evolve into A Modern System
Fragmented ambulance services evolve into a modern system Situated in the Indian Ocean, separated from India by the Palk Strait, Sri Lanka is the 25th largest island in the world (See Figure 1). Its complex geographical features-peaks, plateaus, valleys, rivers and tropical forests-are subject to a variety of natural hazards, including floods, landslides, cyclones and tsunamis.1 With ancient cultural roots going back to the 6th century B.C., Sri Lanka's modern colonial history began with Portuguese, Dutch and British settlements in the 16th century. By 1815, Britain was the sole colonial power. In 1948, Sri Lanka became an...
Source: JEMS Operations - November 2, 2017 Category: Emergency Medicine Authors: Nuwan Chamara Ekanayaka, EMT-I Tags: International Operations Source Type: news

Is postspinal hypotension a sign of impaired cardiac performance in the elderly? An observational mechanistic study
Conclusions. A decrease in cardiac output from baseline before spinal anaesthesia and an inability to increase it after induction may be important features of postspinal hypotension in elderly patients.
Source: British Journal of Anaesthesia - October 10, 2017 Category: Anesthesiology Source Type: research

Novel method for intraoperative assessment of cerebral autoregulation by paced breathing
Conclusions. During surgery, cerebral autoregulation indices were similar to values determined before surgery. This indicates that CA can be quantified reliably and non-invasively using this novel method and confirms earlier evidence that CA is unaffected by sevoflurane anaesthesia.Clinical trial registration. NCT03071432.
Source: British Journal of Anaesthesia - October 6, 2017 Category: Anesthesiology Source Type: research

Embolization for the treatment of intractable epistaxis: 12 month outcomes in a two centre case series.
CONCLUSION: Embolization for epistaxis is safe and effective. Of those who had recurrent epistaxis post embolization, most were taking P2Y12 inhibition and/or anticoagulation. We prefer bilateral distal internal maxillary artery and unilateral facial artery embolization under general anesthesia for optimal safety and efficacy. Advances in knowledge: Embolization with this technique seems to facilitate superior outcomes without complications despite the large proportion of patients taking anticoagulating or P2Y12 inhibiting agents. PMID: 28972795 [PubMed - as supplied by publisher]
Source: The British Journal of Radiology - October 3, 2017 Category: Radiology Authors: Robinson AE, McAuliffe W, Phillips TJ, Phatouros CC, Singh TP Tags: Br J Radiol Source Type: research

Lack of benefit of near-infrared spectroscopy monitoring for improving patient outcomes. Case closed?
Near-infrared spectroscopy (NIRS) monitoring of regional cerebral oxygen saturation (rSco2) during cardiac surgery has been available to clinicians for more than three decades.12 This monitoring is attractive because it is non-invasive, requires minimal user technical expertise, provides an intuitively important end point (oxygenation of the superficial cerebral cortex), and has a continuous output. As a result of these features, NIRS monitoring overcomes many of the limitations of existing monitors for judging adequacy of cerebral perfusion during surgery [(particularly, throughout cardiopulmonary bypass (CPB)], such as e...
Source: British Journal of Anaesthesia - September 8, 2017 Category: Anesthesiology Source Type: research

Comparison of two stroke volume variation-based goal-directed fluid therapies for supratentorial brain tumour resection: a randomized controlled trial
ConclusionsDuring GDFT for supratentorial brain tumour resection, fluid boluses targeting a lower SVV are more beneficial than a restrictive protocol.Clinical trial registrationNCT02113358.
Source: British Journal of Anaesthesia - July 17, 2017 Category: Anesthesiology Source Type: research

Some light in the grey zone?
Treatment of shock is not a new concern in intensive care medicine. The highest priority in patients with shock is the restoration of oxygen delivery. Fluid resuscitation is the very first goal of increasing cardiac output and oxygen delivery in patients with acute circulatory insufficiency. First, based on the simple physiology of the Frank –Starling mechanism, fluid loading should increase cardiac output (CO) by increasing preload and subsequently increasing left ventricular (LV) stroke volume.1 However, fluid overload, especially in patients with pre-existing or developing cardiac failure, can end in only a fractional...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research

Predictor of fluid responsiveness in the ‘grey zone’: augmented pulse pressure variation through a temporary increase in tidal volume
Conclusion: In mechanically ventilated patients, our augmented PPV successfully predicted fluid responsiveness in the previously suggested grey zone.Clinical trial registration: ClinicalTrials.gov, NCT02653469.
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research

Elevated preoperative heart rate is associated with cardiopulmonary and autonomic impairment in high-risk surgical patients
Conclusions. Elevated preoperative heart rate is associated with impaired cardiopulmonary performance consistent with clinically unsuspected, subclinical cardiac failure.Clinical trial registration. ISRCTN88456378.
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research

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