11 Mar 10
Posted in General at 7:52 by Laci
By K Polderman
Intensive Care Med 2004;30:556–575
Hypothermia has been used for medicinal purposes since ancient times. This paper reviews the current potential clinical applications for mild hypothermia (32–35oC).
Design and setting
Induced hypothermia is used mostly to prevent or attenuate neurological injury, and has been used to provide neuroprotection in traumatic brain injury, cardiopulmonary resuscitation, stroke, and various other disorders. The evidence for each of these applications is discussed, and the mechanisms underlying potential neuroprotective effects are reviewed. Some of this evidence comes from animal models, and a brief overview of these models and their limitations is included in this review.
Results
The duration of cooling and speed of re-warming appear to be key factors in determining whether hypothermia will be effective in preventing or mitigating neurological injury. Some other potential usages of hypothermia, such as its use in the perioperative setting and its application to mitigate cardiac injury following ischemia and reperfusion, are also discussed. Conclusions: Although induced hypothermia appears to be a highly promising treatment, it should be emphasized that it is associated with a number of potentially serious side effects, which may negate some or all of its potential benefits. Prevention and/or early treatment of these complications are the key to successful use of hypothermia in clinical practice. These side effects, as well as various physiological changes induced by cooling, are discussed in a separate review.
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15 Jul 09
Posted in General at 19:20 by Laci
By A Clay and B Hainline
Chest 2007;132:1368-1378
Patients experiencing acute elevations of ammonia present to the ICU with encephalopathy, which may progress quickly to cerebral herniation. Patient survival requires immediate treatment of intracerebral hypertension and the reduction of ammonia levels. When hyperammonemia is not thought to be the result of liver failure, treatment for an occult disorder of metabolism must begin prior to the confirmation of an etiology. This article reviews ammonia metabolism, the effects of ammonia on the brain, the causes of hyperammonemia, and the diagnosis of inborn errors of metabolism in adult patients.
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30 Jan 09
Posted in General at 0:28 by Laci
By I Gustavsena, JG Bramnessb, S Skurtveitb, A Engelandb, I Neutele and J Mørlanda
Sleep Medicine 2008;9:818-822
Despite the high prescription rate of benzodiazepine-like hypnotics (z-hypnotics), there is limited information on the road traffic accident risk associated with the use of these drugs. We wanted to investigate whether filling a prescription for zopiclone or zolpidem was associated with increased risk of road traffic accidents at a national population level. Nitrazepam and flunitrazepam were used as comparator drugs.
Method
All Norwegians 18–69 years (3.1 million) were followed-up from January 2004 until the end of September 2006. Information on prescriptions, road traffic accidents and emigration/death was obtained from three Norwegian population-based registries. The first week after the hypnotics had been dispensed was considered to be the exposure period. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of accidents in the exposed person-time to the incidence of accidents in the unexposed person-time.
Results
During exposure, 129 accidents were registered for zopiclone, 21 for zolpidem, 27 for nitrazepam and 18 for flunitrazepam. The SIRs were (SIR for all ages and both sexes combined; 95% CI): z-hypnotics (zopiclone + zolpidem) 2.3; 2.0–2.7, nitrazepam 2.7; 1.8–3.9 and flunitrazepam 4.0; 2.4–6.4. The highest SIRs were found among the youngest users for all hypnotics.
Conclusions
This study found that users of hypnotics had a clearly increased risk of road traffic accidents. The SIR for flunitrazepam was particularly high.
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20 Jan 09
Posted in General at 10:00 by Laci
By J Eisenach, A Borgeat, Z Bosnjak, T Brennan, J Kersten, E Kochs, J Lerman, D Warner, J Wiener-Kronish
Anesthesiology 2008;109:962-972
Welcome to the 2008 year in review, highlighting articles that the Editorial Board believes exemplify the mission of Anesthesiology, to advance the science and practice of perioperative, critical care, and pain medicine through the promotion of seminal discovery. Our goals are to remind you of articles that may change your clinical practice today, to help you better understand the scientific basis of current practice, and to provide glimpses into the future. We recognize how busy you are and hope these brief synopses guide you to new and relevant information.
The full-text on-line articles are a click away at our newly redesigned Web site-www.anesthesiology.org -described more fully in an editorial in this issue.1 In addition to the synopses chronicled in this review, the Anesthesiology Web site now offers new functionality, such as most viewed or most in the press, that will also help you to determine the most relevant and important content for your practice and research. Two thousand eight is the first full calendar year during which content is regularly highlighted through the American Society of Anesthesiologists Press Release office, and the press release program has met with remarkable success. Throughout the year, several news releases were picked up by more than 1,000 news outlets, including nearly all the major news media entities. As Editors, we are very excited about the public interest in research and other content published in the Journal because press interest stresses the critically important medical advances in our specialty and offers well-deserved recognition to the outstanding authors who publish with us.
This year saw the reorganization of our Table of Contents into the three major medical branches of our specialty: perioperative, critical care, and pain medicine. Although we could have organized these synopses into these three areas, we chose to provide a more clinically focused approach. As such, the first six articles address preoperative assessment; the next eight articles address intraoperative care, and the final four articles address postoperative and critical care.
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