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Perioperative Stroke: Comment
Source: Anesthesiology - September 15, 2021 Category: Anesthesiology Source Type: research

Computer-assisted Individualized Hemodynamic Management Reduces Intraoperative Hypotension in Intermediate- and High-risk Surgery: A Randomized Controlled Trial
ConclusionsIn patients having intermediate- to high-risk surgery, computer-assisted individualized hemodynamic management significantly reduces intraoperative hypotension compared to a manually controlled goal-directed approach.Editor ’s PerspectiveWhat We Already Know about This TopicHemodynamic management strategies bracketing predetermined ranges of arterial pressure and flow variables have been demonstrated to reduce certain perioperative complicationsIndividualized hemodynamic management using closed-loop control of blood pressure and a decision support system for fluid titration appears feasible using proprietary m...
Source: Anesthesiology - July 14, 2021 Category: Anesthesiology Source Type: research

Assisted Fluid Management Software Guidance for Intraoperative Fluid Administration
ConclusionsFluid boluses recommended by the software resulted in desired SV increases more often, and with greater absolute SV increase, than clinician-initiated boluses. Automated assessment of fluid responsiveness may help clinicians optimize intraoperative fluid management during noncardiac surgery.Editor ’s PerspectiveWhat We Already Know about This TopicIntraoperative fluid management, restrictive or liberal fluid administration, and goal-directed protocols are controversialAutomated software using artificial intelligence techniques is being developed for various intraoperative management tasksWhat This Article Tell...
Source: Anesthesiology - July 14, 2021 Category: Anesthesiology Source Type: research

Safety of Tranexamic Acid in Hip and Knee Arthroplasty in High-risk Patients
ConclusionsAlthough effective in reducing blood transfusions, tranexamic acid is not associated with increased complications, irrespective of patient high-risk status at baseline.Editor ’s PerspectiveWhat We Already Know about This TopicThe use of tranexamic acid to decrease blood loss during lower-extremity arthroplasty is commonplaceSafety concerns remain for patients with a history of thromboembolic, cardiovascular, renal, or neurologic comorbiditiesWhat This Article Tells Us That Is NewNational administrative data from more than 500 hospitals and 40,000 patients demonstrate that approximately half of high-risk patien...
Source: Anesthesiology - June 9, 2021 Category: Anesthesiology Source Type: research

Stroke in Surgical Patients A Narrative Review
Stroke is associated with substantial morbidity and mortality. The aim of this review is to provide an evidence-based synthesis of the literature related to perioperative stroke, including its etiology, common risk factors, and potential risk reduction strategies. In addition, the authors will discuss screening methods for the detection of postoperative cerebral ischemia and how multidisciplinary collaborations, including endovascular interventions, should be considered to improve patient outcomes. Lastly, the authors will discuss the clinical and scientific knowledge gaps that need to be addressed to reduce the incidence ...
Source: Anesthesiology - February 10, 2021 Category: Anesthesiology Source Type: research

Goal-directed versus Standard Fluid Therapy to Decrease Ileus after Open Radical Cystectomy A Prospective Randomized Controlled Trial
Conclusions Goal-directed fluid therapy may not be an effective strategy for lowering the risk of postoperative ileus in patients undergoing open radical cystectomy.Editor ’s PerspectiveWhat We Already Know about This TopicPostoperative ileus is a common complication after intraabdominal surgeriesPrevious studies have found mixed evidence for benefit in goal-directed intraoperative fluid therapy over standard fluid therapyWhat This Article Tells Us That Is NewIn a randomized trial of goal-directedversus standard fluid therapy in patients having radical cystectomy, there was no difference in the primary outcome of postope...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Shadowing the Abbot: Wood Library-Museum Graphic Illustrators Bill and Janet Lyle
An earlier vignette reflected Wood Library-Museum (WLM) exhibit designer John Byrne “Shadowing the Abbess.” We now segue with “Shadowing the Abbot”: Father John Henry (bottom, standing left), the final Abbot of St. Herman ’s Monastery in Cleveland, Ohio. When the monastery’s wheelchair lift at the men’s shelter needed repairs, these were funded by the author and accomplished by electrician William “Bill” Lyle (upper left). Before mastering the Ohio electrical code to full licensurewithout a mentor, Mr. Lyle had taught himself every graphics version of Photoshop and Illustrator. I have never met a brighter...
Source: Anesthesiology - June 17, 2020 Category: Anesthesiology Source Type: research

Cannabis Use Disorder and Perioperative Outcomes in Major Elective Surgeries A Retrospective Cohort Analysis
Conclusions An active cannabis use disorder is associated with an increased perioperative risk of myocardial infarction.Editor ’s PerspectiveWhat We Already Know about This TopicCannabis is known to have cardiovascular and psychoactive effectsThe association between active cannabis use disorder and postoperative outcomes remains unclearWhat This Article Tells Us That Is NewIn the United States, administrative data demonstrate that cannabis use disorder has increased in prevalence from 2010 to 2015Active cannabis use disorder is not associated with a change in overall perioperative morbidity, mortality, length of stay, or...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery
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.
Source: Anesthesiology - December 13, 2019 Category: Anesthesiology Source Type: research

Four-factor Prothrombin Complex Concentrate for the Management of Patients Receiving Direct Oral Activated Factor X Inhibitors
Direct oral anticoagulants (DOACs) have been approved for the prevention of stroke and systemic embolism in atrial fibrillation, treatment and secondary prevention of venous thromboembolism (VTE), and thromboprophylaxis after major orthopedic surgery. DOACs achieve anticoagulation by inhibiting specific coagulation factors; apixaban, betrixaban, edoxaban, and rivaroxaban inhibit activated factor X, whereas dabigatran inhibits thrombin (factor IIa). In contrast to vitamin K antagonists such as warfarin, DOACs have more predictable pharmacokinetics and pharmacodynamics and fewer interactions with other medications and food, ...
Source: Anesthesiology - October 15, 2019 Category: Anesthesiology Source Type: research

Internal Carotid Artery Blood Flow Response to Anesthesia, Pneumoperitoneum, and Head-up Tilt during Laparoscopic Cholecystectomy
Conclusions During laparoscopic cholecystectomy, internal carotid artery blood flow declined with anesthesia and with pneumoperitoneum, in close association with reductions in cardiac index and MAP. Head-up tilt caused no further reduction. Cardiac output independently affects human cerebral blood flow.
Source: Anesthesiology - August 13, 2019 Category: Anesthesiology Source Type: research

Hypotension and Stroke in Cardiac Surgery: Reply
Source: Anesthesiology - June 18, 2019 Category: Anesthesiology Source Type: research

Hypotension and Stroke in Cardiac Surgery: Comment
Source: Anesthesiology - June 18, 2019 Category: Anesthesiology Source Type: research

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