Methods for the determination of skeletal muscle blood flow: development, strengths and limitations

Abstract

Since the first measurements of limb blood flow at rest and during nerve stimulation were conducted in the late 1800s, a number of methods have been developed for the determination of limb and skeletal muscle blood flow in humans. The methods, which have been applied in the study of aspects such as blood flow regulation, oxygen uptake and metabolism, differ in terms of strengths and degree of limitations but most have advantages for specific settings. The purpose of this review is to describe the origin and the basic principles of the methods, important aspects and requirements of the procedures. One of the earliest methods, venous occlusion plethysmography, is a noninvasive method which still is extensively used and which provides similar values as other more direct blood flow methods such as ultrasound Doppler. The constant infusion thermodilution method remains the most appropriate for the determination of blood flow during maximal exercise. For resting blood flow and light-to-moderate exercise, the non-invasive ultrasound Doppler methodology, if handled by a skilled operator, is recommendable. Positron emission tomography with radiolabeled water is an advanced method which requires highly sophisticated equipment and allows for the determination of muscle-specific blood flow, regional blood flows and estimate of blood flow heterogeneity within a muscle. Finally, the contrast-enhanced ultrasound method holds promise for assessment of muscle-specific blood flow, but the interpretation of the data obtained remains uncertain. Currently lacking is high-resolution methods for continuous visualization and monitoring of the skeletal muscle microcirculation in humans.

from Physiology via xlomafota13 on Inoreader https://ift.tt/2rDfv5G
via IFTTT

Calif. county says new opioid overdose tracking program shows progress

Of the nine overdoses paramedics responded to since the tracking began, health officials have reached three people—and gotten one into a sober living program

from EMS via xlomafota13 on Inoreader https://ift.tt/2jUFkKl
via IFTTT

Physical Activity Levels Predict Exercise-induced Hypoalgesia in Older Adults

Prior research indicates that older adults exhibit a deficient capacity to activate multiple pain inhibitory mechanisms, including pain inhibition after acute exercise termed exercise-induced hypoalgesia (EIH). The influence of physical activity levels and psychological processes on EIH in older adults remains unclear. PURPOSE This study examined potential psychological and physical activity predictors of the magnitude of EIH following submaximal isometric exercise in healthy older adult men and women. METHODS Fifty-two healthy older adults completed a test of EIH, the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia, and wore an accelerometer on the hip for one week to assess physical activity levels. For the test of EIH, participants complete a 3-minute isometric handgrip at 25% of maximum voluntary contraction. Pressure pain thresholds (PPTs) and a 30-sec continuous heat pain test were completed before and immediately after the exercise. RESULTS Mixed model ANOVAs revealed that older adults demonstrated significantly decreased PPTs following isometric exercise (p=.030), and no changes on the heat pain trials from pre to post test (p>.05). A multiple regression revealed that accumulated moderate to vigorous physical activity (MVPA) per week significantly predicted the change in PPT following exercise (β=0.35, p=.012). Participants who averaged greater MVPA experienced a greater increase in PPTs after exercise. No relationships were found with EIH and the psychological variables. CONCLUSIONS Older adults did not exhibit EIH following submaximal isometric exercise. However, those who did more MVPA per week experienced a greater magnitude of pain inhibition following acute exercise. Corresponding Author: Dr. Kelly M. Naugle, Department of Kinesiology, Indiana University Purdue University Indianapolis, 901 West New York St., Indianapolis, IN 46202. Email: kmnaugle@iupui.edu This research was supported by the IUPUI School of Physical Education and Tourism Management Faculty Research Opportunity Grant. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and the results of the present study do not constitute endorsement by ACSM. There are not actual or potential conflicts of interest for any of the authors. © 2018 American College of Sports Medicine

from Sports Medicine via xlomafota13 on Inoreader https://ift.tt/2Gd2K6b
via IFTTT

In Response

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2rDkpzy
via IFTTT

A Contemporary Analysis of Medicolegal Issues in Obstetric Anesthesia Between 2005 and 2015

BACKGROUND: Detailed reviews of closed malpractice claims have provided insights into the most common events resulting in litigation and helped improve anesthesia care. In the past 10 years, there have been multiple safety advancements in the practice of obstetric anesthesia. We investigated the relationship among contributing factors, patient injuries, and legal outcome by analyzing a contemporary cohort of closed malpractice claims where obstetric anesthesiology was the principal defendant. METHODS: The Controlled Risk Insurance Company (CRICO) is the captive medical liability insurer of the Harvard Medical Institutions that, in collaboration with other insurance companies and health care entities, contributes to the Comparative Benchmark System database for research purposes. We reviewed all (N = 106) closed malpractice cases related to obstetric anesthesia between 2005 and 2015 and compared the following classes of injury: maternal death and brain injury, neonatal death and brain injury, maternal nerve injury, and maternal major and minor injury. In addition, settled claims were compared to the cases that did not receive payment. χ2, analysis of variance, Student t test, and Kruskal-Wallis tests were used for comparison between the different classes of injury. RESULTS: The largest number of claims, 54.7%, involved maternal nerve injury; 77.6% of these claims did not receive any indemnity payment. Cases involving maternal death or brain injury comprised 15.1% of all cases and were more likely to receive payment, especially in the high range (P = .02). The most common causes of maternal death or brain injury were high neuraxial blocks, embolic events, and failed intubation. Claims for maternal major and minor injury were least likely to receive payment (P = .02) and were most commonly (34.8%) associated with only emotional injury. Compared to the dropped/denied/dismissed claims, settled claims more frequently involved general anesthesia (P = .03), were associated with delays in care (P = .005), and took longer to resolve (3.2 vs 1.3 years; P

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2wCkbO4
via IFTTT

The Perioperative Care of the Transgender Patient

An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient. Accepted for publication February 27, 2018 Funding: This research was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748. The authors declare no conflicts of interest. All authors were substantial contributors to the conception of the article, were active participants in the drafting and revision of the article, approved the final version of the article, and agree to be accountable for all aspects of the work. Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines: This article adheres to the appropriate EQUATOR guidelines Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0. Reprints will not be available from the authors. Address correspondence to Luis Etienne Tollinche, MD, FASA, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. Address e-mail to tollincl@mskcc.org. © 2018 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2rEgUZA
via IFTTT

Effects of Intraoperative Opioid Use on Recurrence-Free and Overall Survival in Patients With Esophageal Adenocarcinoma and Squamous Cell Carcinoma

BACKGROUND: Perioperative opioid use is associated with poor survival in patients with esophageal squamous cell carcinoma. The most common histological type of esophageal cancer in western countries is adenocarcinoma. The objective of this study was to evaluate the association between intraoperative opioid consumption and survival in patients with adenocarcinoma and squamous cell carcinoma of the esophagus. METHODS: Records of patients who had undergone esophageal cancer surgery between January 2000 and January 2017 were reviewed. Comparisons were made between patients who received high versus low intraoperative doses of opioids. Groups were divided using the recursive partitioning method. Multicovariate Cox proportional hazards models were fitted to evaluate the impact of intraoperative opioid use on recurrence-free survival (RFS) and overall survival (OS). RESULTS: For patients with esophageal squamous cell carcinoma, the univariable analysis indicated that lower opioid dosages (

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2KlbeuH
via IFTTT

Misconceptions Surrounding Penicillin Allergy: Implications for Anesthesiologists

Administration of preoperative antimicrobial prophylaxis, often with a cephalosporin, is the mainstay of surgical site infection prevention guidelines. Unfortunately, due to prevalent misconceptions, patients labeled as having a penicillin allergy often receive alternate and less-effective antibiotics, placing them at risk of a variety of adverse effects including increased morbidity and higher risk of surgical site infection. The perioperative physician should ascertain the nature of previous reactions to aid in determining the probability of the prevalence of a true allergy. Penicillin allergy testing may be performed but may not be feasible in the perioperative setting. Current evidence on the structural determinants of penicillin and cephalosporin allergies refutes the misconception of cross-reactivity between penicillins and cefazolin, and there is no clear evidence of an increased risk of anaphylaxis in cefazolin-naive, penicillin-allergic patients. A clinical practice algorithm for the perioperative evaluation and management of patients reporting a history of penicillin allergy is presented, concluding that cephalosporins can be safely administered to a majority of such patients. Accepted for publication March 30, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Leon Vorobeichik, MD, Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Room M3-200, Toronto, ON M4N 3M5, Canada. Address e-mail to l.vorobeichik@mail.utoronto.ca. © 2018 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2rFkFxW
via IFTTT

A modified CO2/O2 Guedel airway improves capnographic accuracy compared with a CO2/O2 nasal cannula: An infant manikin study

BACKGROUND Capnography via a CO2/O2 nasal cannula is commonly used for respiratory monitoring during sedation. However, signal disturbances are frequently encountered, especially in young children. OBJECTIVE Sampling ports placed closer to the trachea have been shown to result in improved signal quality. In a manikin model of a 6-month-old infant we compared capnography from a modified Guedel airway with a CO2 port located at the tip with that from a CO2/O2 nasal cannula. DESIGN A comparison study using an artificial model of a breathing 6-month-old infant. SETTING Department of Paediatrics, Inselspital Bern, Switzerland, from March 2016 to June 2016. MATERIAL Modified CO2/O2 Guedel airway. INTERVENTIONS Capnography using a modified CO2/O2 Guedel airway or a CO2/O2 nasal cannula was performed for tidal volumes of 20 to 80 ml (in steps of 20 ml), respiratory rates of 20 to 60 min−1 (in steps of 10 min−1) and with different O2 flows (0 to 2 l min−1, in steps of 0.5 l). MAIN OUTCOME MEASURES Comparison of differences between tracheal and device CO2. Secondary outcomes included the effect of various respiratory settings and O2 flows on the CO2 difference. RESULTS The tracheal to device CO2 difference was significantly smaller when using a modified CO2/O2 Guedel airway vs. a CO2/O2 nasal cannula: Mean ± SD, 16.8 ± 4.9 vs. 24.1 ± 5.9 mmHg, P less than 0.0001. An O2 flow of 0.5 to 2 l min−1 did not influence the tracheal to device CO2 difference with the modified CO2/O2 Guedel airway in contrast to the CO2/O2 nasal cannula where there were significant differences (P 

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2rFYneL
via IFTTT

Duration of the action of rocuronium in patients with BMI of less than 25: An observational study

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear. OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN A prospective, observational, single-centre study. SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI 

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2IdARkr
via IFTTT

Placebo versus low-dose ketamine infusion in addition to remifentanil target-controlled infusion for conscious sedation during oocyte retrieval: A prospective, double-blinded, randomised controlled trial

BACKGROUND Currently, there is no gold standard for monitored anaesthesia care during oocyte retrieval. OBJECTIVE In our institution, the standard is a conscious sedation technique using a target-controlled infusion (TCI) of remifentanil, titrated to maintain a visual analogue pain score less than 30 mm. This protocol is well accepted by patients but is associated with frequent episodes of respiratory depression. The main objective of this study was to evaluate whether the addition of a continuous intravenous infusion of ketamine could reduce these episodes. DESIGN Controlled, randomised, prospective, double-blinded study. SETTING The current study was conducted in a tertiary-level hospital in Brussels (Belgium) from December 2013 to June 2014. PATIENTS Of the 132 women undergoing oocyte retrieval included, 121 completed the study. INTERVENTION After randomisation, patients received either a ketamine infusion (40 μg kg−1 min−1 over 5 min followed by 2.5 μg kg−1 min−1) or a 0.9% saline infusion in addition to the variable remifentanil TCI. MAIN OUTCOME MEASURES The primary outcome was the number of respiratory depression episodes. Effect site target remifentanil concentrations, side effects, pain score, patient satisfaction and incidence of pregnancy were also recorded. RESULTS No significant difference in the incidence of respiratory events was noted (pulse oximetry oxygen saturation 

from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2rEPAcW
via IFTTT

Can telerehabilitation games lead to functional improvement of upper extremities in individuals with Parkinson’s disease?

Parkinson's disease (PD) is treated by medication, less with deep brain stimulation and physiotherapy. Different opinions on the clinical meaningfulness of the physiotherapy or recommended intensive physiotherapy were found. Our objectives were to design intensive target-based physiotherapy for upper extremities suitable for telerehabilitation services and examine the clinical meaningfulness of the exergaming at an unchanged medication plan. A telerehabilitation exergaming system using the Kinect sensor was developed; 28 patients with PD participated in the study. The system followed the participants' movements and adapted the difficulty level of the game in real time. The outcomes of the study showed that seven out of 26 participants could set up the equipment at home alone. Clinical outcomes of Box and Blocks Test (mean: 47 vs. 52, P=0.002, Cohen's d=0.40), UPDRS III (mean: 27 vs. 29, P=0.001, d=0.22), and daily activity Jebsen's test; writing a letter (mean: 24.0 vs. 20.6, P=0.003, d=0.23); and moving light objects (mean: 4.4 vs. 3.9, P=0.006, d=0.46) were statistically significant (P

from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2Khwr8C
via IFTTT

Predicting self-reported disability level by a number of pain sites marked on pain drawing

To evaluate the connection between the number of pain sites (head and neck, upper extremities, trunk, and lower extremities) marked on pain drawing and general disability level measured by a 12-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) score. A cross-sectional survey of 1988 patients with chronic musculoskeletal pain was conducted. Analysis of variance with contrasts was performed along with regression analysis. Despite the relatively mild median disability level measured as WHODAS 2.0 total score at 25%, the majority of the participants experienced, in the last month, severe pain with 8.1 points on a 0–10 numeric rating scale. Only 1% had left the pain drawing unmarked. Otherwise, 15% had marks in one area, 34% in two, 23% in three, and 27% in all four areas. The characteristics of those groups were similar except for disability. Disability level was 30–50% worse when pain was experienced in all four sites. The analysis of variance showed that both the number of pain sites and pain severity affected disability level (P

from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2rDdZQY
via IFTTT

Comorbidities Associated with Early Mortality in Adults with Spina Bifida

Objective The purpose of this quality improvement project was to identify secondary conditions and medical comorbidities in adult patients with spina bifida and to determine which factors were associated with an earlier age of death. Design Retrospective chart review of 487 patients who attended the University of Pittsburgh Medical Center (UPMC) Adult Spina Bifida Clinic between August 1, 2005 and June 6, 2017. Results Out of 487 patients who had received care at the UPMC Adult Spina Bifida Clinic, 48 were deceased. The most commonly reported causes of death included infection, respiratory failure, renal failure, shunt malfunction and metastatic cancer. Underlying comorbidities and secondary conditions included hydrocephalus, Chiari II malformation, tethered cord, scoliosis, and abnormal renal function. In deceased patients, earlier age of death was significantly associated with myelomeningocele (MMC) subtype and the presence of hydrocephalus and Chiari II malformation. Conclusion Clinicians treating individuals with spina bifida should be aware of the potential for earlier mortality in individuals with MMC, hydrocephalus, and Chiari II malformation, especially with regard to infection, respiratory failure, renal failure, shunt malfunction, and cancer. Correspondence should be directed to: Brad E. Dicianno, MD, Human Engineering Research Laboratories, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh PA 15206. 412-822-3700. (dicianno@pitt.edu) Author disclosures: This study has not previously been presented or published in any form. This study was supported by the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine. The authors have no competing conflicts of interest or financial incentives related to this quality improvement project. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2IcEpDF
via IFTTT

The prevalence of scoliosis in spina bifida subpopulations: a systematic review

Prevalence of scoliosis within spina bifida subpopulations is important for diagnostics and therapeutic purposes. This review determined the prevalence of scoliosis within spina bifida subpopulations by means of a systematic literature review by using the following databases: Medline-Pubmed, Embase, Cochrane and Pedro. All Dutch- and English-written literature using the MESH-terms: "Spinal Dysraphism", "Neural Tube Defects", "Scoliosis" was analysed using the exclusion criteria: animal studies, case reports, studies regarding the prevalence of spina bifida among patients with scoliosis, studies with inclusion of patients with scoliosis 10°, studies without an own study group, articles comprising the same patient group as another article, neural tube defects besides spina bifida and articles without specification of spina bifida subtype. It resulted in six articles, two concerning diastematomyelia (103 patients, 82 females and 21 males), four about myelomeningocele (479 patients, 283 females and 196 males) with an overall weighted prevalence of scoliosis (20° Cobb angle cut off) of 44.4% and 52.5% respectively. It can be concluded that most studies have a lot of methodological flaws so there is a need for further research with standardisation of data collection to allow comparison of different data. Address correspondence to: Arne Heyns, Physical and Rehabilitation Medicine, University Hospitals Leuven, Belgium, Herestraat 49, 3000 Leuven. Fax: 016 34 21 84. Tel: +324 96 36 45 39, email: arne.heyns@uzleuven.be Competing interests: none of the authors has any competing interest. Funding source: The research had no specific support. Financial disclosure statement: The authors have no financial relationships relevant to this article to disclose. Conflict of interest statement: The authors have no conflicts of interest relevant to this article to disclose. Presentations: the article will be presented at the upcoming ESPRM congress 2018 in Vilnius. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2IgYyEx
via IFTTT

Ultrasound-guided injection of botulinum toxin for cricopharyngeal dysphagia

No abstract available

from Rehabilitation via xlomafota13 on Inoreader https://ift.tt/2jRBCAU
via IFTTT

Copyright

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2KYKmBx
via IFTTT

Contributors

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2GcbnxY
via IFTTT

Contents

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2jUt9gm
via IFTTT

Forthcoming Issues

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2GbLDSq
via IFTTT

Practice Management: Successfully Guiding Your Group into the Future

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): Amr E. Abouleish, Stanley W. Stead




from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2jUt1xo
via IFTTT

Overlapping Surgery

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): Amanda J. Morris, Joseph A. Sanford, Edward J. Damrose, Samuel H. Wald, Bassam Kadry, Alex Macario

Teaser

A keystone of operating room (OR) management is proper OR allocation to optimize access, safety, efficiency, and throughput. Access is important to surgeons, and overlapping surgery may increase patient access to surgeons with specialized skill sets and facilitate the training of medical students, residents, and fellows. Overlapping surgery is commonly performed in academic medical centers, although recent public scrutiny has raised debate about its safety, necessitating monitoring. This article introduces a system to monitor overlapping surgery, providing a surgeon-specific Key Performance Indicator, and discusses overlapping surgery as an approach toward OR management goals of efficiency and throughput.


from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2Gdpseq
via IFTTT

Quality Reporting

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): DeLaine Schmitz, Matthew T. Popovich

Teaser

Since the 1990s, the use of quality measures in healthcare has grown exponentially. Practices must maintain current knowledge of measures that affect their clinicians locally and understand how assessment of these medical professionals affects the priorities and quality activities of practices and facilities. Because quality measures are increasingly used by hospital administrators, health plans, and payers, practices are being asked to shoulder the additional burdens of collecting and reporting data to various entities. Part of the solution to this increased burden often includes contracting with vendors and outside experts, as well as identifying effective local physician and practice champions.


from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2rCk1kU
via IFTTT

Comprehensive Preoperative Assessment and Global Optimization

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): Neil N. Shah, Thomas R. Vetter

Teaser

To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.


from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2KlxILN
via IFTTT