ANESTHESIOLOGIE REANIMATION HAITI (HUEH)

San Francisco—Although general anesthesia and conscious sedation seem to equally affect functional independence at discharge in patients with acute ischemic stroke undergoing endovascular intervention therapy, patients who received general anesthesia experienced significantly greater mortality than their counterparts, researchers have found. Whether this difference is directly attributable to anesthesia type, however, is unclear, as the duration of intra-arterial therapy and time to revascularization from symptom onset were both significantly longer in patients who received general anesthesia, according to the study. “Ischemic stroke has an extremely high mortality rate—16%—in patients presenting for first-time stroke,” said Kathryn Rosenblatt, MD, an anesthesiology resident at SUNY Upstate Medical University, in Syracuse, N.Y., who helped conduct the study. “Endovascular clot retrieval helps remove intracranial clot occlusions in ischemic stroke patients. Although the therapy can

For women giving birth, nitrous oxide may be a viable alternative to having an epidural block, a recent study has found. Although the researchers were quick to point out that nitrous oxide (N2O) may not be for everyone, it could stand in when an epidural block is contraindicated, or for women who simply do not wish to receive one. Likewise, they note that NO offers a safe alternative to IV narcotics. The retrospective cohort study, presented at the 2014 Pregnancy Meeting (abstract 598), examined the outcomes of 6,192 laboring women at the University of California, San Francisco Medical Center (UCSF) between 2007 and 2012. The investigators focused on single-child, head-down births with no unusual complications. NO was administered using an FDA-approved device called the Nitronox (Porter Instruments). The researchers accounted for the effects of age, ethnicity, insurance status and the length of each stage of labor in their comparison of outcomes between women who received N2O an

Article Outline Abstract 1. Introduction 2. Pathogenesis 2.1. Genetic factors 2.2. Molecular alterations 2.2.1. Calcium channels 2.2.2. Nitric oxide 2.2.3. Endothelin-1 2.2.4. Cytokines 2.2.5. Toll-like receptors 2.3. Metabolic alterations 2.3.1. Ischemia 2.3.2. Mitochondrial dysfunction and oxidative stress 2.3.3. Autonomic dysregulation 2.4. Structural modifications 2.5. Hemodynamic alterations: from sepsis to myocardial dysfunction 2.5.1. Decreased intravascular volume (reduced preload) 2.5.2. Decreased vascular tone (reduced afterload) 2.5.3. Microcirculatory alterations 2.5.4. VO2/DO2 dependency 2.5.5. Lactate 2.5.6. Mechanical ventilation and septic cardiomyopathy 3. Left and right ventricular dysfunction: double trouble 3.1. Septic cardiomyopathy 3.2. Diagnostic tools 3.2.1. Pulmonary artery catheter 3.2.2. Tissue Doppler imaging 3.2.3. Myocardial perfusion echocardiography 4. Treatment 4.1. Hemodynamic stabilization 4.1.1. Fluid ther