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Anesthesia for Patients with Peripheral Vascular Disease and Cardiac Dysfunction
Publication date: December 2016 Source:Anesthesiology Clinics, Volume 34, Issue 4 Author(s): Sara E. NevesTeaser Patients with vascular disease and cardiac dysfunction present particular challenges to the anesthesiologist. They are hemodynamically brittle, at high risk of morbidity and mortality during surgery, and often carry additional comorbidities that increase their complexity and risk. Those with peripheral vascular disease should be assumed to have coronary artery disease and tend to have other systemic vascular problems. Poor cardiac function further worsens perfusion in an already compromised peripheral vascular ...
Source: Anesthesiology Clinics - November 2, 2016 Category: Anesthesiology Source Type: research

Old Drug, New Route: A Systematic Review of Intravenous Acetaminophen After Adult Cardiac Surgery
THE MANAGEMENT OF postoperative pain after cardiac surgery remains clinically challenging. Well-controlled pain is critical to maintaining the physical and psychologic well-being of each patient and can help facilitate timely extubation, comfortable breathing, and early postoperative ambulation. On the other hand, left poorly managed, postoperative pain can lead to rising catecholamine levels, ultimately triggering myocardial ischemia, stroke, or bleeding complications.1-3 Insufficient pain control also can limit patient mobility, increasing the risk of deep vein thrombosis and pneumonia, in addition to the harmful psychol...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2016 Category: Anesthesiology Authors: Daniel J. Douzjian, Alexander Kulik Tags: Review ArticleGiovanni Landoni, MDSection Editors? > Source Type: research

Post‐operative serious adverse events in a mixed surgical population – a retrospective register study
ConclusionWe found a risk of one or more events in the composite outcome within 342 days after inclusion of the last patients of 8.3% (7.8–9.0). The results are applicable in estimations of adequate sample sizes in future clinical trials investigating effects of interventions on SAEs.
Source: Acta Anaesthesiologica Scandinavica - July 15, 2016 Category: Anesthesiology Authors: M. S. Hansen, E. E. Petersen, J. B. Dahl, J. Wetterslev Tags: Original Article Source Type: research

Post ‐operative serious adverse events in a mixed surgical population – a retrospective register study
ConclusionWe found a risk of one or more events in the composite outcome within 342 days after inclusion of the last patients of 8.3% (7.8–9.0). The results are applicable in estimations of adequate sample sizes in future clinical trials investigating effects of interventions on SAEs.
Source: Acta Anaesthesiologica Scandinavica - July 13, 2016 Category: Anesthesiology Authors: M. S. Hansen, E. E. Petersen, J. B. Dahl, J. Wetterslev Tags: Original Article Source Type: research

Validation of a novel index of hemorrhage using a lower body negative pressure shock model.
CONCLUSION: iHAT measures both the reduction in preload and the parabolic heart rate increase due to the linear decrease in stroke volume. iHAT was able to detect a progressive central volume loss in a model of hemorrhage in healthy volunteers undergoing LBNP. A rising trend in iHAT can be a useful marker for progressive volume loss during moderate to severe bleeding. PMID: 26756378 [PubMed - as supplied by publisher]
Source: Minerva Anestesiologica - January 16, 2016 Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research

A Case of Fatal Bleeding Following Emergency Surgery on an Ascending Aorta Intramural Hematoma in a Patient Taking Dabigatran
INTRAMURAL HEMATOMA (IMH) is an acute aortic syndrome. More frequently—in 60% to 70% of cases—IMH involves the descending aorta (type B), whereas the involvement of the ascending aorta and aortic arch accounts for 30% and 10% of the cases, respectively. Hospital mortality of type-A IMH is similar to type-A aortic dissection. Cardiocirculatory shock secondary to cardiac tamponade, together with stroke, coma, and impaired coronary perfusion, are important predictive factors of postoperative mortality.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 13, 2016 Category: Anesthesiology Authors: Giulia Beatrice Crapelli, Paolo Bianchi, Giuseppe Isgrò, Andrea Biondi, Carlo de Vincentiis, Marco Ranucci Tags: Case Report Source Type: research

Preoperative evaluation and comprehensive risk assessment for children with Down syndrome
Summary Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations...
Source: Pediatric Anesthesia - January 12, 2016 Category: Anesthesiology Authors: Amy Feldman Lewanda, Andrew Matisoff, Mary Revenis, Ashraf Harahsheh, Craig Futterman, Gustavo Nino, Jay Greenberg, John S. Myseros, Kenneth N. Rosenbaum, Marshall Summar Tags: Special Interest Article (Review) Source Type: research

Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.
Abstract Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recom...
Source: Paediatric Anaesthesia - January 9, 2016 Category: Anesthesiology Authors: Lewanda AF, Matisoff A, Revenis M, Harahsheh A, Futterman C, Nino G, Greenberg J, Myseros JS, Rosenbaum KN, Summar M Tags: Paediatr Anaesth Source Type: research

The Effect of Cardiopulmonary Bypass on Dabigatran Levels
DABIGATRAN IS a novel anticoagulant that is licensed for use for the prevention of stroke in the presence of atrial fibrillation. Its use has expanded rapidly in New Zealand, primarily due to there being no requirement for routine monitoring of its effect, as there is for warfarin. There are case reports in the literature describing management of patients coming for urgent cardiac surgery, which revolve mainly around the use of dialysis and massive transfusion of clotting factors to manage the bleeding associated with surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 31, 2015 Category: Anesthesiology Authors: Kelly Byrne Tags: CASE REPORT Source Type: research

Peri‐operative cardiac protection for non‐cardiac surgery
Summary Cardiovascular complications are an important cause of morbidity and mortality after non‐cardiac surgery. Pre‐operative identification of high‐risk individuals and appropriate peri‐operative management can reduce cardiovascular risk. It is important to continue chronic beta‐blocker and statin therapy. Statins are relatively safe and peri‐operative initiation may be beneficial in high‐risk patients and those scheduled for vascular surgery. The pre‐operative introduction of beta‐blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should o...
Source: Anaesthesia - December 1, 2015 Category: Anesthesiology Authors: S. S. C. Wong, M. G. Irwin Tags: Review Article Source Type: research

Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: An analysis of the implications for perioperative management.
Abstract Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and f...
Source: Annals of Cardiac Anaesthesia - October 1, 2015 Category: Anesthesiology Authors: Mookadam M, Shamoun FE, Ramakrishna H, Obeid H, Rife RL, Mookadam F Tags: Ann Card Anaesth Source Type: research

New therapy in cardioprotection
Purpose of review: An increasing number of patients are presenting for major surgery with cardiovascular comorbidities. Evidence of myocardial injury was found in 8% of all noncardiac surgery patients older than 45 years and was associated with adverse outcome. For this reason, there has been a lot of interest in finding and evaluating effective cardioprotective interventions. Recent findings: Current evidence suggests that statins, volatile anesthetic agents, and propofol are cardioprotective. Beta blockers reduce myocardial injury, but the resultant hypotension may contribute to the increased all-cause mortality and stro...
Source: Current Opinion in Anaesthesiology - July 3, 2015 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Tong J. Gan Source Type: research

Hemorrhagic stroke and new oral anticoagulants.
Abstract The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addi...
Source: Annales Francaises d'Anesthesie et de Reanimation - October 1, 2014 Category: Anesthesiology Authors: Derlon V, Corbonnois G, Martin M, Toussaint-Hacquard M, Audibert G Tags: Ann Fr Anesth Reanim Source Type: research

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