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Pharmacokinetics of Magnesium in Cardiac Surgery: Implications for Prophylaxis Against Atrial Fibrillation
Postoperative atrial fibrillation (POAF) is the most common cardiovascular complication in patients undergoing cardiac surgery. The risk of POAF depends on the type of procedure, and ranges from 30% in patients undergoing coronary artery bypass surgery to 50% in those undergoing combined procedures. Patients who develop POAF have an increased risk of a number of other complications, including stroke and a prolonged hospital stay, and have a higher risk of death during long-term follow-up.1 The precise mechanism of POAF is unknown, but it is obvious that numerous preoperative, intraoperative, and postoperative factors might...
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 4, 2017 Category: Anesthesiology Authors: Vladimir V. Lomivorotov, Sergey M. Efremov, Alexander M. Karaskov Tags: Editorial Source Type: research

Subarachnoid Hemorrhage
Publication date: September 2016 Source:Anesthesiology Clinics, Volume 34, Issue 3 Author(s): Jeremy S. Dority, Jeffrey S. OldhamTeaser Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cereb...
Source: Anesthesiology Clinics - August 9, 2016 Category: Anesthesiology Source Type: research

Cerebral protection during neurosurgery and stroke
This article reviews the recent evidence on perioperative neuroprotection in patients undergoing brain surgery and in patients with acute stroke. Recent findings: With varying degrees of success, numerous pharmacological and nonpharmacological therapies have been employed to provide neuroprotection for patients during the perioperative period and after acute ischemic stroke (IAS). Recent studies have failed to demonstrate neuroprotective effects of intraoperative remifentanil or propofol use, although hypertonic saline may provide better brain relaxation than mannitol during elective intracranial surgery for tumor. Magnesi...
Source: Current Opinion in Anaesthesiology - September 3, 2015 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Keith J. Ruskin Source Type: research

Update on anesthetic neuroprotection
Purpose of review: Perioperative cerebral injury can result in a wide range of clinical consequences from subtle cognitive changes to devastating or fatal strokes. Although the overall incidence of perioperative stroke is low, the large and growing number of aging patients undergoing surgery and anesthesia is placing an increasing number of vulnerable patients at risk. The purpose of this review is to evaluate recent evidence concerning the use of pharmacological and nonpharmacological strategies to protect against perioperative cerebral injury. Recent findings: Although a growing body of preclinical literature suggests th...
Source: Current Opinion in Anaesthesiology - July 3, 2015 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Tong J. Gan Source Type: research

Postoperative ICU management of patients after subarachnoid hemorrhage
This article reviews recent advances in the postoperative ICU management of patients after subarachnoid hemorrhage (SAH), especially with regards to hemodynamic management, methods of improving neurological outcomes, and management of cardiac and pulmonary complications. Recent findingsSeveral hemodynamic monitors and parameters may be useful for guiding volume therapy, including cardiac output, stroke volume variation monitoring, and global end-diastolic volume index. Early goal-directed hemodynamic therapy after SAH has recently been shown to improve clinical outcomes in patients with a poor clinical grade or coexisting ...
Source: Current Opinion in Anaesthesiology - October 1, 2014 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Kristin Engelhard Source Type: research