Preoperative Evaluation of Patients with Diabetes Mellitus

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Joshua D. Miller, Deborah C. Richman

Teaser

There are more than 29 million people in the United States with diabetes; it is estimated that by 2050, one in 3 individuals will have the disease. At least 50% of patients with diabetes are expected to undergo surgery in their lifetime. Complications from uncontrolled diabetes can impact multiple organ systems and affect perioperative risk. In this review, the authors discuss principles in diabetes management that will assist the perioperative clinician in caring for patients with diabetes.


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Preoperative Assessment of Geriatric Patients

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Justin G. Knittel, Troy S. Wildes

Teaser

Geriatric patients are over-represented in hospitalizations, surgeries, and perioperative complications. Special consideration is required for this patient group in the perioperative period because of the prevalence of comorbid diseases, functional impairments, and other deficits. A comprehensive preoperative evaluation strategy is recommended to identify and address these issues. Systematic, multidomain assessments should be performed and paired with risk reduction efforts. A shared understanding of patient function and long-term health goals is also important for providing patient-centered care of the geriatric surgical patient.


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Implantable Devices

Publication date: March 2016
Source:Anesthesiology Clinics, Volume 34, Issue 1
Author(s): Ana Costa, Deborah C. Richman

Teaser

Technology is the prominent feature of the twenty-first century, including in medicine. There are very few organs that cannot be stimulated, shocked, or infused. With more and more implantable devices being approved for clinical use, anesthesiologists have to regularly take care of patients who have these devices. An understanding of the devices, the associated comorbidities, and the perioperative risks is crucial for safe management of these patients. Cardiac devices are discussed in some detail; neurostimulators and other implantable devices are briefly described. The principles of assessment and management are similar for all patients with implanted devices.


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The effect of permissive hypotension in combined traumatic brain injury and blunt abdominal trauma: an experimental study in swines

OBJECTIVE: Optimal hemodynamic resuscitation strategy of the trauma patient with uncontrolled hemorrhage and severe head injury in the pre-hospital setting remains a special challenge. Permissive hypotension prior to definite surgical haemostasis promotes coagulation, decreases blood loss and favors survival. However, hypotension is associated with poor outcome in severe head injury. The purpose of this experimental animal study was to assess the impact of permissive hypotension on survival, hemodynamic profile and brain oxygenation parameters before and/or after definite surgical haemostasis.

PATIENTS AND METHODS: Six-week-old pigs (n=12) underwent general anesthesia and brain injury was produced by the fluid percussion model. Animals were instrumented to measure hemodynamic parameters and cerebral blood flow. All animals (n=12) were subjected to laparotomy and a surgical knot was placed through the abdominal aorta wall. Uncontrolled hemorrhage was simulated by pulling out the intentionally left protruding free ends of the suture (goal MAP=30 mmHg). Animals were randomly divided into two groups; group A (n=6) was subjected to aggressive fluid resuscitation (goal SAP >80 mmHg) and group B (n=6) was left hypotensive (permissive hypotension). Animals who survived one hour of hypotensive shock underwent definite surgical haemostasis and were resuscitated for one hour. We measured survival, hemodynamic and brain oxygenation parameters at different time points before and after surgical haemostasis.

RESULTS: All animals from Group A and 50% from Group B died before surgical haemostasis. In surviving animals (Group B, 50%, p=0.033), MAP, CO, rCBF, SjO2 and AVDO2 were restored to pre-procedural levels.

CONCLUSIONS: Permissive hypotension by delaying fluid resuscitation up to definite surgical haemostasis improves survival, hemodynamics and allows restoration of cerebral oxygenation in severe head injury.

L'articolo The effect of permissive hypotension in combined traumatic brain injury and blunt abdominal trauma: an experimental study in swines sembra essere il primo su European Review.

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Management of Avian pox in Turkeys

2016-02-27T23-59-58Z
Source: International Journal of Livestock Research
Chaitanya yalavarthi, deepthi balam, Ramesh putchakayala.
Turkey poults were presented to clinic with cutaneous pustules all over body. Based on findings of clinical examination and lesions it was diagnosed as Avian pox. Successful management of Avian pox with procain pencillin and clinical outcome were discussed.


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Reproductive and Early Growth Traits of Intensively Reared West African Dwarf (WAD) Kids in a Humid Tropical Environment

2016-02-27T23-59-58Z
Source: International Journal of Livestock Research
Paul Chidiebere Okafor, Cosmas Chikezie Ogbu, Hariet Ndofor-Foleng.
The objectives of the study were to evaluate the reproductive, early growth and linear body traits of WAD goats reared intensively. Twenty-five WAD goats (20 does and 5 bucks) aged 7-8 months (9.0 to 12.0kg bwt) were mated naturally (1 buck: 4 does) to generate the kids studied. Animals were managed intensively. Kids suckled their dams until weaning before being separated. Litter size at birth, sex of kid, body weight (BW) and linear body traits from birth to 6 months of age (moa), weaning weight (Wwt), and mortality from birth to 6moa were evaluated. Data collected were presented using descriptive statistics. Pearson correlation analysis was used to study the relationship between traits. Birth weight was 1.75 ± 0.06kg; litter size was 2.08 ± 0.11 while Wwt was 7.11 ± 0.11kg. Body weight at 2, 4, and 6moa ranged between 4.00 and 5.20kg, 6.10 and 8.20kg, and 9.00 and 12.00kg, respectively. Body weight gain (BWG) at 2, 4, and 6 moa was 48.26 ± 1.16g/day, 52.21 ± 1.24g/day, and 49.39 ± 1.27g/day, respectively. Growth rate from birth to weaning, weaning to 6moa, and birth to 6moa was 45.04 ± 0.80g/d, 51.82 ± 1.30g/d, and 47.15 ± 0.55g/d, respectively. Number of males/litter, number of kids weaned/litter and mortality/litter from birth to 6moa was 0.54 ± 0.08, 1.86 ± 0.13, and 0.39 ± 0.17, respectively. Body weight values at different ages were positively interrelated (P


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Normal and impaired control of functional movements in stroke: Role of neural interlimb coupling

While close cooperation of muscle activation between the two legs during gait has been known for several years, only during recent years has it become evident that the mechanism of "neural interlimb coupling" plays a major role in the control of a number of functional movements. Neural interlimb coupling is defined as a flexible, task-specific, physiologically meaningful linkage of limbs during complex movements. Experimentally, this mechanism can be demonstrated through the analysis of reflex responses.

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