Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations - Part I: Preoperative and intraoperative management.

Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management.

Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced Recovery After Surgery (ERAS®) Society Recommendations - Part II: Postoperative management and special considerations.

Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part II of the guidelines highlights postoperative management and special considerations.

Machine Learning Models of Post-Intubation Hypoxia During General Anesthesia.

Fine-meshed perioperative measurements are offering enormous potential for automatically investigating clinical complications during general anesthesia. In this study, we employed multiple machine learning methods to model perioperative hypoxia and compare their respective capabilities. After exporting and visualizing 620 series of perioperative vital signs, we had ten anesthesiologists annotate the subjective presence and severity of temporary post-intubation oxygen desaturation.

Algorithmic Summaries of Perioperative Blood Pressure Fluctuations.

Automated perioperative measurements such as cardiovascular monitoring data are commonly compared to established upper and lower thresholds, but could also allow for more complex interpretations. Analyzing such time series in extensive electronic medical records for research purposes may itself require customized automation, so we developed a set of algorithms for quantifying different aspects of temporal fluctuations. We implemented conventional measures of dispersion, summaries of absolute gradients between successive values, and Poincaré plots.

Orphan diseases: impact for anesthesia practice.

Purpose Of Review: Orphan diseases certainly have a challenging impact on anesthesia practice. Low prevalence by definition leads to a profound lack of evidence-based medical knowledge, and anesthetists usually cannot rely on personal experience for handling this unique group of patients. Then again, more than 7000 known orphan diseases are estimated to affect 5% of the general population in total.

The sitting position in neurosurgery: indications, complications and results. a single institution experience of 600 cases.

Background: The benefit of the sitting position for surgery of the posterior fossa and cervical spine is still a matter of controversy. In our study we analyzed the outcome after sitting position surgery at our institution. We compared the incidence of venous air embolism (VAE) as recognized with different monitoring techniques and the severity of complications.

Anaesthetic management in patients with Duchenne muscular dystrophy undergoing orthopaedic surgery: a review of 232 cases.

Context: Patients with Duchenne muscular dystrophy are at increased risk of some anaesthesia-related hazards such as rhabdomyolysis, fever and hyperkalaemia.

Objectives: To evaluate the management of anaesthesia in patients with Duchenne muscular dystrophy, including preoperative evaluation, intraoperative performance, critical events and postoperative care.

Design: We performed a retrospective case review study of anaesthesia in patients with Duchenne muscular dystrophy covering the period between April 2000 and December 2008.

Influence of disease progression on the neuromuscular blocking effect of mivacurium in children and adolescents with Duchenne muscular dystrophy.

Background: Studies with nondepolarizing neuromuscular blocking agents showed a delayed onset and prolonged recovery in patients with Duchenne muscular dystrophy. The objective of this study was to investigate if these alterations depend on disease progression.

Methods: The authors studied 11 children (6-9 yr) with moderate Duchenne muscular dystrophy, 11 adolescents (12-16 yr) with advanced Duchenne muscular dystrophy, and 2 age-matched control groups of 8 patients each (5-9 and 10-17 yr).

High post surgical opioid requirements in Crohn's disease are not due to a general change in pain sensitivity.

Crohn's disease (CD) is a painful inflammatory bowel disease with complex multigenic inheritance. Suggested on the basis of a few isolated reports CD patients require significantly higher post operative opioid doses than patients undergoing comparable severe abdominal surgery. Crohn's disease therefore may be a suitable model for the identification of novel pain susceptibility genes.

Pharmacodynamic modelling of rocuronium in adolescents with Duchenne muscular dystrophy.

Background And Objective: Studies with rocuronium showed a delayed onset and prolonged recovery in patients with Duchenne muscular dystrophy (DMD). The objective of this study was to identify the pharmacokinetic and/or pharmacodynamic origin of these alterations.

Methods: Twenty-five male patients (15 with DMD, 10 controls, aged 10-18 years) were studied.

Reversal of rocuronium-induced neuromuscular blockade by pyridostigmine in patients with Duchenne muscular dystrophy.

Background: The aim of this study was to investigate the effect and safety of pyridostigmine for the reversal of a neuromuscular block (NMB) in patients with Duchenne muscular dystrophy (DMD). In patients with DMD recovery from a rocuronium-induced NMB is markedly delayed.

Methods: Fourteen DMD patients (aged between 11 and 19 years) scheduled for elective scoliosis repair were studied.

Rocuronium 0.3 mg x kg-1 (ED95) induces a normal peak effect but an altered time course of neuromuscular block in patients with Duchenne's muscular dystrophy.

Background: In patients with Duchenne's muscular dystrophy (DMD) recovery from neuromuscular block is delayed. It has been assumed that this is because of a higher potency of muscle relaxants in this patient cohort. We determined the peak effect, and the time course of action of rocuronium 0.

Onset and duration of rocuronium-induced neuromuscular blockade in patients with Duchenne muscular dystrophy.

Background: In patients with Duchenne muscular dystrophy (DMD) the response to nondepolarizing muscle relaxants is scarcely documented and conflicting. The current study was conducted to determine the time to peak effect and the time for complete spontaneous recovery after a single dose of 0.6 mg/kg of rocuronium in patients with DMD.

A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles.

Purpose: Priming is a known technique to accelerate onset of neuromuscular blockade (NMB). Its effect on NMB of the larynx has not been studied yet.

Methods: We compared a priming technique with a bolus application of rocuronium on the onset of NMB at the laryngeal adductor and the adductor pollicis muscles (AP).