ANESTHESIOLOGIE REANIMATION HAITI (HUEH)

Many questions have arisen and much controversy has emerged regarding how much fluid should be given perioperatively, which fluids should be given, when they should be given, and whether outcomes can be influenced. It’s been called the “Great Fluid Debate.” In fact, one might ask whether the anesthesiologist can even make a difference in the long run. Several goals of fluid administration have been identified: Tissue perfusion should be optimized; and heart rate, stroke volume, hemoglobin, and oxygen saturation should be appropriately manipulated. But just how to achieve these end points, and whether they can be done by fluid administration, remains unclear. Our current standard therapy—cannulate a vein, give fluids to maintain blood pressure, and make up for supposed losses—has been challenged for almost a century. Canon noted that fluids administered before operative control of an injury were ineffective, 1  an observation emphasized by Bickell and others some 70 years later. ...

The number of deaths involving commonly prescribed painkillers is higher than the number of deaths by overdose from heroin and cocaine combined, according to researchers at McGill University. In a first-of-its-kind review of existing research, the McGill team has put the spotlight on a major public health problem: the dramatic increase in deaths due to prescribed painkillers, which were involved in more than 16,000 deaths in 2010 in the U.S. alone. Currently, the U.S and Canada rank #1 and #2 in per capita opioid consumption. “Prescription painkiller overdoses have received a lot of attention in editorials and the popular press, but we wanted to find out what solid evidence is out there,” says Nicholas King, of the Biomedical Ethics Unit in the Faculty of Medicine. In an effort to identify and summarize available evidence, King and his team conducted a systematic review of existing literature, comprehensively surveying the scientific literature and including only reports with quant...

BONNE FETE DR. DAPHNE N. PIERRE (R2)

Pregnancy causes anatomical and physiological changes that have implications for the anaesthetist not only for intrapartum management but also when surgery is required incidentally to pregnancy. These adaptations primarily occur, so that the metabolic demands of the growing fetus may be met. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SOURCE

Ketamine, an injectable anesthetic that has been shown to exert a rapid but short-lived antidepressant effect, may reduce suicidal ideation independently of a reduction in depressive symptoms, new research suggests. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SOURCE

Tracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg −1  and propofol 2.0–3.0 mg·kg −1  or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil. Methods . Eighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg −1 , remifentanil 0.30 μg kg min −1  and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg −1 . We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery. Results . Acceptable intubating conditions were seen more frequently ...

Use of benzodiazepines to treat  insomnia  or  anxiety  may increase the risk for Alzheimer's disease (AD), new research suggests. Dr. Sophie Billioti de Gage A case-control study of nearly 9000 older individuals showed that risk for AD was increased by 43% to 51% in those who had "ever used" benzodiazepines in the previous 5 years. The association was even stronger in participants who had been prescribed benzodiazepines for 6 months or longer ― and in those who used long-acting versions of the medications. Lead author Sophie Billioti de Gage, PharmD, who is also a PhD student and researcher at INSERM Unit 657–Pharmacoepidemiology at the University of Bordeaux, France, told Medscape Medical News  that the overall results were not a surprise because the short-term deleterious effects of these medications on memory are well documented. A study published by the same researchers last year showed a 50% increased risk for dementia in patients using ...