Effect of General Anesthesia in Infancy on Long-Term Recognition Memory in Humans and Rats.

Stratmann G et al

Neuropsychopharmacology. 2014 Jun 9.

The authors compared twenty eight children ages 6-11 who had undergone a procedure requiring general anesthesia before age 1 to twenty eight age- and gender-matched children who had not undergone anesthesia.

 Recollection and familiarity were assessed in an object recognition memory test using receiver operator characteristic analysis. In addition, IQ and Child Behavior Checklist scores were assessed.

 In parallel, thirty three 7-day old rats were randomized to receive anesthesia or sham anesthesia. Over ten months, recollection and familiarity were assessed using an odor recognition test.

They found that anesthetized children had significantly lower recollection scores and were impaired at recollecting associative information compared to controls. Familiarity, IQ, and Child Behavior Checklist scores were not different between groups.

In rats, anesthetized subjects had significantly lower recollection scores than controls while familiarity was unaffected. Rats that had undergone tissue injury during anesthesia had similar recollection indices as rats that had been anesthetized without tissue injury.

These findings suggest that general anesthesia in infancy impairs recollection later in life in humans and rats. In rats, this effect is independent of underlying disease or tissue injury.

Clevidipine compared with nitroglycerin for blood pressure control in coronary artery bypass grafting: a randomized double-blind study.

Merry AF, Avery EG, Nussmeier NA, Playford HR, Warman GR, Wang Y, Sladen RN.

Can J Anaesth. 2014 May;61(5):398-406

The investigators tested the hypothesis that clevidipine, a rapidly acting dihydropyridine calcium channel blocker, is not inferior to nitroglycerin (NTG) in controlling blood pressure before cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG).

100 patients undergoing CABG with CPB were randomized at four centres to receive intravenous infusions of clevidipine (0.2-8 μg·kg(-1)·min(-1)) or NTG (0.4 μg·kg(-1)·min(-1) to a clinician-determined maximum dose rate) from induction of anesthesia through 12 hr postoperatively. 

The study drug was titrated in the pre-CPB period with the aim of maintaining mean arterial pressure (MAP) within ± 5 mmHg of a clinician-predetermined target.

Total mean [standard deviation (SD)] dose pre-bypass was 4.5 (4.7) mg for clevidipine and 6.9 (5.4) mg for NTG (P < 0.05).

CONCLUSION:

During CABG, clevidipine was not inferior to NTG for blood pressure control pre-bypass.

Anesthetic considerations in pregnant women at advanced maternal age.

J Matern Fetal Neonatal Med. 2014 Apr 9. 

Orbach-Zinger S, Aviram A, Ioscovich A, Listengart M, Reuveni A, Fein S, Eidelman LA, Yogev Y.

Anesthesia management of parturients aged 45 years and above is comparable to the management of women aged 40-44 years. However, parturients ≥45 are more susceptible to

bleeding complications. 

Of note, parturients aged ≥ 45 years had an approximately eight-fold risk for postpartum hemorrhage.

Effects of a head elevated ramped position during elective caesarean delivery after combined spinal-epidural anaesthesia.

Cheesman K, Massey S, Preston R, Albert A, Douglas J.

Int J Obstet Anesth.     2014 May;23(2):106-12.

Elevating the parturient undergoing elective caesarean delivery into the Head Elevated Ramped Position immediately or once the block had been established did not appear to significantly alter time to an adequate block height of T4; however, the need for epidural supplementation was greater in the intervention groups. Cautious use of this novel position change can provide a more comfortable experience and provide a better airway position should conversion to general anaesthesia be required.

Procalcitonin as a predictor of sepsis and outcome in severe trauma patients: a prospective study.

Rajkumari N, Mathur P, Sharma S, Gupta B, Bhoi S, Misra MC

J Lab Physicians. 2013 Jul;5(2):100-8.

Patients with high initial PCT levels (>2 ng/ml) in severe trauma cases had poor outcomes and risk of developing complications. Its correlation with severe outcomes was better marked as compared with CRP and ESR levels. The difference in PCT levels between days 1 and 4 in group two patients was statistically significant (P = 0.006) but were not statistically significant for CRP (P = 0.646) and ESR (P = 0.935). The study also shows that PCT levels fall in response to appropriate antimicrobial treatment.