Rethinking postoperative nausea and vomiting prevention beyond perioperative medications

Journal of Clinical Anesthesia, Journal Year: 2024, Volume and Issue: 95, P. 111457 - 111457

Published: March 29, 2024

Language: Английский

---

The Effect of Low-Dose Dexmedetomidine on Perioperative Neurocognitive Dysfunction in Elderly Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP): A Randomized, Controlled, Double-Blind Trial

Drug Design Development and Therapy, Journal Year: 2024, Volume and Issue: Volume 18, P. 3715 - 3725

Published: Aug. 1, 2024

This study investigates the effect of low-dose dexmedetomidine infusion on perioperative neurocognitive function in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Language: Английский

---

The Influence of Regional Anesthesia on the Systemic Stress Response

Reports — Medical Cases Images and Videos, Journal Year: 2024, Volume and Issue: 7(4), P. 89 - 89

Published: Nov. 2, 2024

Background: The systemic stress response to surgery is a complex physiological process characterized by neuroendocrine, sympathetic, and inflammatory activation. While necessary for survival, this can lead adverse outcomes such as hyperglycemia, immune suppression, cardiovascular complications, delayed recovery. Regional anesthesia (RA) has been shown modulate more effectively than general (GA) blocking nociceptive signaling attenuating the release of mediators. Objectives: This review aims elucidate how RA influences response, highlighting its clinical benefits in reducing postoperative pain, improving hemodynamic stability, minimizing responses, preserving function. Additionally, examines evidence from trials supporting using improve surgical outcomes, particularly high-risk populations. Methods: A comprehensive narrative literature was conducted explore impact on associated outcomes. Studies comparing GA across various procedures were evaluated, focusing neuroendocrine modulation, sympathetic inhibition, attenuation, implications pain management, pulmonary function, preservation. Results: significantly attenuates cortisol catecholamines, thereby stability myocardial oxygen consumption. also inhibits nervous system, leading improved Furthermore, mitigates pro-inflammatory cytokine levels, risk syndrome (SIRS), sepsis, complications. Clinical studies meta-analyses consistently demonstrate that reduces opioid consumption, incidence elderly patients. Conclusions: offers significant advantage modulating surgery, enhancing Its are pronounced populations or those with pre-existing comorbidities. Given growing efficacy, should be considered critical component multimodal perioperative care strategies aimed at Future research optimize techniques identify patient-specific factors enhance therapeutic benefits.

Language: Английский

---

Dexamethasone alleviates etomidate-induced myoclonus by reversing the inhibition of excitatory amino acid transporters

Frontiers in Neuroscience, Journal Year: 2024, Volume and Issue: 18

Published: June 24, 2024

Background Etomidate can induce myoclonus with an incidence of 50 ~ 85% during anesthesia induction. Dexamethasone, as a long-acting synthetic glucocorticoid, has neuroprotective effects. However, the effects dexamethasone on etomidate-induced remain uncertain. Methods Adult male Sprague–Dawley rats were randomly assigned to receive etomidate (1.5 mg/kg) plus (4 (etomidate group) or same volume normal saline (NS) NS group). The mean behavioral scores, local field potentials and muscular tension recorded explore myoclonus. Liquid chromatography coupled tandem mass spectrometric system (LC–MS/MS), quantitative real-time polymerase chain reaction (qRT-PCR), western blotting applied analyze levels glutamate γ -aminobutyric acid (GABA), mRNA protein expression excitatory amino transporters (EAATs), plasma corticosterone at different time points after anesthesia. Results Compared treatment, treatment significantly decreased score 1, 3, 4, 5 min administration; peak power spectral density (PSD) ( p = 0.0197) in analysis ripple waves; level 0.0139) neocortex. compared NS, increased neocortical proteins EAAT1 0.0207) EAAT2 0.0022) aggravated inhibition 4 h 0.0019), 0.0041), 6 0.0009) administration. Conclusion Dexamethasone attenuate myoclonus, inhibit accumulation, reverse suppression EAATs neocortex induced by following while conversely aggravating adrenal suppression.

Language: Английский

---

Analysis of the Effects of Epidural Anesthesia on the Nociception Level Index (NOL®) during Abdominal Surgery

Published: July 26, 2024

Background: The NOL system (PMD-200™ Nociception Monitor; Medasense Ltd, Israel) is used for real-time detection of physiological nociception in anesthetized patients by assessing varia-bles indicative sympathetic activity, such as photoplethysmography, skin conductance, pe-ripheral temperature, and accelerometry, which are quantified into a "NOL" index. This index more sensitive than traditional clinical parameters estimating pain stress responses. While its effectiveness general anesthesia well-documented, efficacy epidural anes-thesia needs investigation. Methods: retrospective study analyzed dynamics compared to conventional pa-rameters after administration local anesthetic during abdominal surgeries. After Ethics Committee approval DRKS registration, 119 measurements were retrospectively following thoracic catheter administration. values assessed at 0, 1, 3, 5 minutes post-application heart rate, blood pressure, bispectral in-dex dynamics. Results: studys showed significant decrease post-local admin-istration, unlike classical parameters. Higher doses anesthetics led signifi-cant, dose-dependent Conclusions: the first demonstrate NOL-Index's nociceptive effects post-epidural administration, showing superiority over sensitivity dose variations.

Language: Английский

---

Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines

Acute and Critical Care, Journal Year: 2024, Volume and Issue: 39(3), P. 331 - 340

Published: Aug. 30, 2024

Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due its complex, multiple-cause pathophysiology varied presentations. CIRCI, characterized by adrenal during illness, presents up 30% of ICU patients may manifest an exaggerated inflammatory response. Factors dysregulation hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue resistance, drug-induced suppression contribute CIRCI. Diagnosis is a complex process, relying on comprehensive assessment including clinical presentation, laboratory findings, dynamic stimulatory testing. Treatment involves intensive medical exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored patient presentation etiology. Understanding treatment CIRCI vital clinicians managing critically ill striving improve outcomes. This research paper aims explore latest developments management

Language: Английский

---

Morbidities and mortality among hospitalized patients with hypopituitarism: Prevalence, causes and management

Reviews in Endocrine and Metabolic Disorders, Journal Year: 2024, Volume and Issue: 25(3), P. 599 - 608

Published: May 27, 2024

Abstract Hypopituitarism is a highly heterogeneous multisystem disorder that can have major impact on long-term morbidity and mortality, but even more so during acute medical conditions requiring hospitalization. Recent studies suggest significant in-hospital burden with prolonged length of stay, increased rate intensive care unit (ICU) admission, initiation mechanical ventilation − all which may lead to an risk mortality. On the one hand, patients hypopituitarism are often burdened by metabolic complications, including obesity, hypertension, dyslipidemia, hyperglycemia, alone, or in combination, known significantly alter relevant physiological mechanisms, metabolism, innate adaptive immune responses, coagulation, wound healing, thereby contributing adverse outcomes. other depending extent number pituitary hormone deficiencies, early recognition deficiencies appropriate management replacement strategy within well-organized multidisciplinary team stronger determinants short-term outcomes hospitalization this vulnerable patient population. This review aims provide up-to-date summary recent advances pathophysiologic understanding, clinical implications, recommendations for optimized hospitalized hypopituitarism.

Language: Английский

---

Influence of the Antimycotic Drug Itraconazole on Plasma Cortisol Levels and Blood Pressure in a Patient with Burnout Syndrome

Biomedical and Biotechnology Research Journal (BBRJ), Journal Year: 2024, Volume and Issue: 8(1), P. 135 - 140

Published: Jan. 1, 2024

Burnout is a syndrome that increasingly common nowadays. It associated with reduced work efficiency and chronic exhaustion. The main cause of burnout continuous stress at not enough rest. system involved in the pathogenesis hypothalamic–pituitary–adrenocortical axis final substrate glucocorticoid hormone cortisol. Therefore, patients syndrome, morning plasma cortisol levels are elevated, but there no significant change its evening values. This correlates an increase blood pressure, weight gain, muscle weakness, low immunity, etc. following case report about unusual effect antifungal drug itraconazole on circadian rhythm levels, as well pressure patient syndrome. One month peroral application 100 mg every day reduces to greatest extent (by approximately 37%) rather than circa 17.5%). decrease mean ambulatory systolic diastolic also uniform (it stronger – 27% 17%).

Language: Английский

---

周術期低用量ステロイド補充プロトコルへの変更に伴う安全性と有効性の検討

Folia Endocrinologica Japonica, Journal Year: 2024, Volume and Issue: 100(S.HPT), P. 12 - 15

Published: Aug. 2, 2024

---

Analysis of the Effects of Epidural Anesthesia on the Nociception Level Index (NOL®) during Abdominal Surgery

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(16), P. 4968 - 4968

Published: Aug. 22, 2024

Background: The NOL® system (PMD-200™ Nociception Level Monitor; Medasense Ltd., Ramat Gan, Israel) is used for the real-time detection of physiological nociception in anesthetized patients by assessing parameters indicative sympathetic activity, such as photoplethysmography, skin conductance, peripheral temperature, and accelerometry, which are quantified into NOL®-Index. This index more sensitive than traditional clinical estimating pain stress responses. While its effectiveness general anesthesia well documented, efficacy epidural needs further investigation. Methods: retrospective study analyzed NOL®-Index dynamics compared to conventional after administration bupivacaine. Following ethics committee approval, 119 measurements were retrospectively thoracic catheter 40 undergoing abdominal urological surgery. NOL-Index® was assessed at 0, 1, 3, 5 min post application heart rate, blood pressure, bispectral dynamics. Results: showed a significant decrease post-local-anesthetic with better sensitivity classical (0 = 38 ± 11; 1 22 13*; 3 17 11*; 12 10*). Higher doses local anesthetics led significant, dose-dependent (low dose, 15 10*; high 8 8*). Conclusions: first demonstrate measuring nociceptive effects following administration, highlighting potential superiority over dose variations.

Language: Английский

---