Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 6 Articles
Background: Goal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of\r\nstay following major surgery. However, there has been no assessment regarding its use in clinical practice.\r\nMethods: An electronic survey was administered to randomly selected anaesthetists from the United Kingdom\r\n(UK, n = 2000) and the United States of America (USA, n = 2000), and 500 anaesthetists from Australia/New Zealand\r\n(AUS/NZ). Preferences, clinical use and attitudes towards GDFT were investigated. Results were collated to examine\r\nregional differences.\r\nResults: The response rates from the UK (n = 708) and AUS/NZ (n = 180) were 35%, and 36% respectively. The\r\nresponse rate from the USA was very low (n = 178; 9%). GDFT use was significantly more common in the UK than in\r\nAUS/NZ (p < 0.01). The Oesophageal Doppler Monitor was the most preferred instrument in the UK (n = 362; h76%)\r\nwith no clear preferences in other regions. GDFT was most commonly utilised in major abdominal surgery and for\r\npatients with significant comorbidities. The commonest reasons stated for not using GDFT were either lack of\r\navailability of monitoring tools (AUS/NZ: 57 (70%); UK: 94 (64%)) or a lack of experience with instruments (AUS/NZ:\r\n43 (53%); UK: 51 (35%)). A subset of respondents (AUS/NZ: 22(27%); UK: 45 (30%)) felt GDFT provided no perceived\r\nbenefit. Enthusiasm towards the use of GDFT in the absence of existing barriers was high.\r\nConclusion: Several hypotheses were generated regarding important differences in the use of GDFT between\r\nanaesthetists from the UK and AUS/NZ. There is significant interest in utilising GDFT in clinical practice and existing\r\nbarriers should be addressed....
Background: Most studies that follow up hepatectomy cases are limited in scope to an investigation of mortality\r\nand morbidity rates or the costs and length of hospital stay. In this study the authors aimed to characterize the\r\nquality of life and to evaluate mortality and its determinants after hepatectomy.\r\nMethods: This prospective study was carried in a Post-Anaesthesia Care Unit (PACU) over 15 months, and 70\r\npatients submitted to hepatectomy were enrolled. Demographic and peri-operative characteristics were evaluated\r\nfor associations with mortality. At admission and 6 months after discharge, patients completed a Short Form-36\r\nquestionnaire (SF-36) and have their independence in Activities of Daily Living (ADL) was evaluated. Binary and\r\nmultiple logistic regression analyses were used to evaluate of associations with mortality, and the Wilcoxon signed\r\nrank test was used to compare SF-36 scores before and after 6 months after hepatectomy.\r\nResults: The mortality rate was 19% at 6 months. Multivariate analysis identified postoperative delirium as an\r\nindependent determinant for mortality. Six months after discharge, 46% patients stated that their health in general\r\nwas better or much better than that 1 year previously. Six months after hepatectomy, patients had worse scores in\r\nthe physical function domain of SF-36; however, scores for all the other domains did not differ. At this time point,\r\npatients were more dependent in instrumental ADL than before surgery (32% versus 7%, p = 0.027).\r\nConclusion: This study identified postoperative delirium as an independent risk factor for mortality 6 months after\r\nhepatectomy. After 6 months, survivors were more dependent in instrumental ADL tasks and had worse scores in\r\nthe physical function domain of SF-36....
A study by Burkle et al. in BMC Anesthesiology examined attitudes around perioperative do-not-resuscitate orders.\r\nQuestionnaires were given to patients, as well as to anesthesiologists, internists and surgeons. The study has\r\nlimitations and is open to interpretation. However, the findings are important. There appear to be attitudinal\r\ndifferences between patients and doctors, and between specialties. A small majority of patients are content to have\r\na do-not-resuscitate order postponed during the perioperative period. A large majority expects open\r\ncommunication from doctors before proceeding. However, this article could also encourage a broader debate. This\r\nis about how to respect patient autonomy, while ensuring that resuscitation truly serves the patient�s best interests.\r\nThis commentary outlines how more communication is needed at the bedside and in wider society....
A cohort, double blind, and randomized study was conducted to investigate the effect of a single nucleotide polymorphism of the\r\n??-opioid receptor at nucleotide position 118 (OPRM1:c.118A>G) on the association with the most common side effects (nausea or\r\nvomiting) induced by intravenous patient control analgesia (IVPCA) with morphine, including incidence and severity analysis.\r\nA total of 129 Taiwanese women undergoing gynecology surgery received IVPCA with pure morphine for postoperative pain\r\nrelief. Blood samples were collected and sequenced with high resolution melting analysis to detect three different genotypes of\r\nOPRM1 (AA, AG, and GG). All candidates 24 h postoperatively will be interviewed to record the clinical phenotype with subjective\r\ncomplaints and objective observations. The genotyping after laboratory analysis showed that 56 women (43.4%) were AA, 57\r\n(44.2%) were AG, and 16 (12.4%) were GG. The distribution of genotype did not violate Hardy-Weinberg equilibrium test. There\r\nwas no significant difference neither between the severity and incidence of IVPCA morphine-induced side effects and genotype nor\r\nbetween the association betweenmorphine consumption versus genotype. However, there was significant difference of the relation\r\nbetween morphine consumption and the severity and incidence of IVPCA morphine-induced nausea and vomiting. The genetic\r\nanalysis for the severity and incidence of IVPCA morphine-induced nausea or vomiting showed no association between phenotype\r\nand genotype. It might imply that OPRM1:c.118A>G does not protect against IVPCA morphine-induced nausea or vomiting....
Intracellular pH is a fundamental parameter to cell function that requires tight homeostasis. In the absence of any regulation, excessive acidification of the cytosol would have the tendency to produce cellular damage. Mammalian Na+/H+ exchangers (NHEs) are electroneutral Na+-dependent proteins that exchange extracellular Na+ for intracellular H+. To date, there are 9 identified NHE isoforms where NHE1 is the most ubiquitous member, known as the housekeeping exchanger. NHE1 seems to have a protective role in the ischemia-reperfusion injury and other inflammatory diseases. In nociception, NHE1 is found in neurons along nociceptive pathways, and its pharmacological inhibition increases nociceptive behavior in acute pain models at peripheral and central levels. Electrophysiological studies also show that NHE modulates electrical activity of primary nociceptive terminals. However, its role in neuropathic pain still remains controversial. In humans, NHE1 may be responsible for inflammatory bowel diseases since its expression is reduced in Crohn�s disease and ulcerative colitis. The purpose of this work is to provide a review of the evidence about participation of NHE1 in the nociceptive processing....
Environmental context has an important impact on health and well being. We aimed to test the effects of a visual distraction induced by classical hospital waiting room (RH) versus an ideal room with a sea view (IH), both represented in virtual reality (VR), on subjective sensation and cortical responses induced by painful laser stimuli (LEPs) in healthy volunteers and patients with chronic migraine (CM). Sixteen CM and 16 controls underwent 62 channels LEPs from the right hand, during a fully immersive VR experience, where two types of waiting rooms were simulated. The RH simulated a classical hospital waiting room while the IH represented a room with sea viewing. CM patients showed a reduction of laser pain rating and vertex LEPs during the IH vision. The sLORETA analysis confirmed that in CM patients the two VR simulations induced a different modulation of bilateral parietal cortical areas (precuneus and superior parietal lobe), and superior frontal and cingulate girus, in respect to controls. The architectural context may interfere with pain perception, depending upon the status of subject. Many variables may change patients� outcome and support the use of VR technology to test the best conditions for their management....
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