The tremendous impact of hypoxia on any critical organ, namely the brain and the heart, are well known, at least because of their obvious result. The question asked by many: “For how long can the patient tolerate apnoea?” cannot be answered with certainty for any given patient. The long list of possible problems that may arise during the transport of O2 from the anesthetic circuit to the very last cell of the human organism precludes any possibility of precise calculation. Hypoxia of critical tissues (the brain and the heart) has deleterious pathophysiologic effects on them.
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Perturbations of the clotting system frequently accompany systemic inflammatory states. Coagulation abnormalities, specifically an imbalance between coagulant and anticoagulant mechanisms, are a frequent occurrence in patients with septic shock and trauma and have been associated with an increased mortality.
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This study was undertaken to investigate the efficacy of prehydration with crystalloids or colloids for preventing spinal anaesthesia-induced hypotension in elderly normotensive and hypertensive patients. Eighty physical status ASA I-III elderly patients were enrolled in this study, receiving spinal anesthesia.
Continue readingCardiac stabilization during “off-pump” coronary revascularization (OPCAB) has been implicated in causing intraoperative hemodynamic disturbances. Stroke volume and cardiac output reductions may alter the ventilation/perfusion ratio in the lungs and compromise the gas exchange. This study was conducted to determine the impact of heart’s stabilization on arterial blood-gas profile in patients undergoing OPCAB surgery.
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Neurolytic celiac plexus block (NCPB) is a useful technique for pain control in patients with intra-abdominal tumors or pain secondary to chronic pancreatitis that does not respond to other therapeutic modalities (not interventional). The anterior approach for NCPB has been considered a relatively safe approach, with a low rate of complications and little risk of neurologic injury secondary to the spread of a neurolytic agent. This is the first national case report of successful NCPB using the anterior approach under CT guidance.
Continue readingEthical issues in animal research
Neuroendocrine alterations and new therapeutic approaches in critically ill Patients
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Local and systemic injury due to ischemia-reperfusion
Anesthetic considerations for surgery involving clamping of superior vena cava
Perioperative effect of general and combined (general plus epidural) anesthesia on coagulation parameters of surgical cancer patients
Separation from cardiopulmonary bypass in a nitric oxide non-responder using inhaled nitroglycerin
Accidental tracheal tube cuff puncture during attempted internal jugular vein cannulation. Concerns and recommendations
Intraoperative Transesophageal Echocardiography in High Risk Patients Undergoing Noncardiac Surgery: A Brief Overview and A Case Presentation
Mimicry of narrow-complex VT during arthroscopy
The following article discusses the arguments for and against animal research, emphasizing the philosophical, scientific, and social context of this controversy.
Continue readingAcute and prolonged illness seems to result in a variety of different neuroendocrine alterations. During the acute phase of critical illness there is an actively secreting anterior pituitary gland and a peripheral resistance to anabolic hormones. In the chronic phase of critical illness there is a uniformly reduced secretion of anterior pituitary hormones, with the notable exception of cortisol.
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Technological advances in medicine and the development of intensive care units have faded the frontiers between life and death. Brain death is a diagnosis and there are prerequisite criteria, a differential diagnosis and a decision making process to consider which must be unambiguous, straight forward, understandable and infallible.
Continue readingAcute inflammatory response is the body’s direct response to noxious stimuli or to tissue necrosis. Ischemia-reperfusion lesion is a clinical state of acute inflammation with leucocyte-induced tissue damage. Ischemia promotes an inflammatory response which sensitizes tissues to further damage during reperfusion. Reperfusion activates inflammatory mediators from remote vascular or tissue sites or from the local vascular bed. Reperfusion remains the cornerstone for the repair of ischemic areas.
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