Intraoperative Maintenance of Normoglycemia with Insulin and Glucose Preserves Verbal Learning after Cardiac Surgery.

 Schricker T, Sato H, Beaudry T, Codere T, Hatzakorzian R, Pruessner JC.

 PLoS One. 2014 Jun 18;9(6)

 

Patients were randomly assigned to receive combined administration of insulin and glucose, titrated to preserve normoglycemia (3.5-6.1 mmol L-1; experimental group), or standard metabolic care (blood glucose 3.5-10 mmol L-1; control group), during open heart surgery. The patients' cognitive function was assessed during three home visits, approximately two weeks before the operation, and two months and seven months after surgery.  Questionnaires measuring specific traits known to affect cognitive performance, such as self-esteem, depression, chronic stress and social support, were also administered. The primary outcome was to assess the effect of hyperinsulinemic-normoglycemic clamp therapy versus standard therapy on specific cognitive parameters in patients receiving normoglycemic clamp, or standard metabolic care.

Twenty-six patients completed the study with 14 patients in the normoglycemia and 12 patients in the control group. Multiple analysis of covariance (MANCOVA) for the RAVLT showed a significant effect for the interaction of group by visit (F = 4.07, p = 0.035), and group by visit by recall (F = 2.21, p = 0.04). The differences occurred at the second and third visit. MANCOVA for the digit span task, trail making and word pair association test showed no significant effect.

CONCLUSIONS:

Preserving intraoperative normoglycemia by intravenous insulin and glucose may prevent the impairment of memory function, both short and long-term, after cardiac surgery.

Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years

Ossam Rhondali et al.

Pediatric Anesthesia

Volume 24, Issue 7, pages 734–740, July 2014

Children younger than 2 years, ASA I or II, scheduled for abdominal or orthopedic surgery were included.

 Induction of anesthesia was started by sevoflurane 6% and maintained with an expired fraction of sevoflurane 3%. Mechanical ventilation was adjusted to maintain an endtidal CO₂ around 39 mmHg. Brain oxygenation was assessed measuring regional cerebral saturation of oxygen (rSO₂c), measured by NIRS while awake and 15 min after induction, under anesthesia. Mean arterial pressure (MAP) variation was recorded.

Despite a significant decrease of MAP, 1 MAC of sevoflurane induced a significant increase in regional brain oxygenation. But subgroup analysis showed that MAP decrease had a greater impact on brain oxygenation, in children younger than 6 months. 

According to their results, MAP value during anesthesia should not go under 33 mmHg in children ≤6 months and 43 mmHg in children >6 months, as further changes in MAP, PaCO₂ or hemoglobin during anesthesia may be poorly tolerated by the brain.

Early Administration of Hydrocortisone Replacement After the Advent of Septic Shock: Impact on Survival and Immune Response

Katsenos, Chrysostomos S. et  al on behalf of the Hellenic Sepsis Study Group

Critical Care Medicine:

July 2014 - Volume 42 - Issue 7 - p 1651–1657

Over a 2-year period, 170 patients with septic shock treated with low doses of hydrocortisone were enrolled. Blood was sampled from 34 patients for isolation of peripheral blood mononuclear cells and cytokine stimulation before and 24 hours after the start of hydrocortisone.

 After adjusting for disease severity and type of infection, a protective effect of early hydrocortisone administration against unfavorable outcome was found (hazard ratio, 0.20; p = 0.012).

Time of discontinuation of vasopressors was earlier among patients with initiation of hydrocortisone within 9 hours. Production of tumor necrosis factor-α was lower among patients who had had hydrocortisone early,

This resulted in improved survival.

Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest: Associations With Long-Term Neurologic Outcome

Vaahersalo, Jukka MD; Bendel, Stepani MD, PhD; Reinikainen, Matti MD, PhD; Kurola, Jouni MD, PhD; Tiainen, Marjaana MD, PhD; Raj, Rahul BM; Pettilä, Ville MD, PhD; Varpula, Tero MD, PhD; Skrifvars, Markus B. MD, PhD, FCICM

Critical Care Medicine:

June 2014 - Volume 42 - Issue 6 - p 1463-1470  

This study included out-of-hospital cardiac arrest patients treated in ICUs in Finland between March 2010 and February 2011.

The cerebral performance category at 12 months was used as primary endpoint. 
A total of 409 patients with arterial blood gases analyzed at least once and with a complete set of resuscitation data were included.

In this multicenter study, hypercapnia was associated with good 12-month outcome in patients resuscitated from out-of-hospital cardiac arrest. 

They were unable to verify any harm from hyperoxia exposure.