Hydroxyethyl Starch

Here Today, Gone Tomorrow

J. P. Nolan, M. G. Mythen

Disclosures

Br J Anaesth. 2013;111(3):321-324. 

After a review of the available evidence, on June 14, 2013, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) concluded that the benefits of hydroxyethyl starch (HES) solutions no longer outweighed their risks and recommended that the marketing authorizations for these medicines be withdrawn.^[1] The United Kingdom (UK) Commission on Human Medicines (CHM) concurred and on June 27, 2013, the Medicines and Healthcare Products Regulatory Agency (MHRA) announced the withdrawal of HES products from the UK, giving just 48 h to return all unexpired stock.^[2] In contrast, on June 24, 2013, the United States (US) Food and Drug Administration (FDA) recommended that HES products not be used in critically ill patients or in those with pre-existing renal dysfunction but did not withdraw them completely.^[3]

read more here: http://www.medscape.com/viewarticle/810039

Bougie-Aided Cricothyrotomy by Darren Braude

The bougie can make an open cric much easier. Here is airway Darren Braude, MD demonstrating this technique.

Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice.

These guidelines represent the updated consensus of experts in the field of immediate hypersensitivity reactions occurring during anesthesia. They provide a series of valid, widely accepted, effective, and easily teachable guidelines that are the fruit of current knowledge, research, and experience. The guidelines are based on the findings of international scientific research and have been implemented in France under the auspices of the French Society for Anaesthesia and Intensive Care (Société Française d'Anesthésie et de Réanimation [SFAR]) and the French Society of Allergology (Société Française d'Allergologie [SFA]). The members of the European Network for Drug Allergy approved the guidelines. This paper presents the most relevant clinical implications of the guidelines.

Complete Guideline here.

My patient is allergic to eggs, can i use propofol? A case report and review

an interesting case report by Dr. Jamal Tashkandi

Rather than other drugs, propofol is more likely to be used for induction of anesthesia to cause an allergic reaction. Propofol is becoming the most common intravenous agent used for induction as well as maintenance of anaesthesia. Allergy to propofol is rarely reported. We present a case of 4–year-old boy presented for elective adenotonsillectomy with past medical history of eczema and multiple allergies to food. He developed what seems to be an allergic reaction to propofol. We concluded that anaesthetists should be alerted when using propofol in patients with history of atopy or several drug allergies. Current evidence suggests that egg allergic patients are not more likely to develop anaphylaxis when exposed to propofol. If reactions to drugs occurred, it is always advisable to ascertain the exact allergen in each individual case before deciding causality. Serum tryptase, skin prick, intradermal testing, or serologic testing should be done to confirm the diagnosis of an anaphylactic reaction.

source: Saudi Journal of Anesthesia

Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care

The autonomic nervous system (ANS) plays an important role in the human response to various internal and external stimuli, which can modify homeostasis, and exerts a tight control on essential functions such as circulation, respiration, thermoregulation and hormonal secretion. ANS dysfunction may complicate the perioperative course in the surgical patient undergoing anesthesia, increasing morbidity and mortality, and, therefore, it should be considered as an additional risk factor during pre‐operative evaluation. Furthermore, ANS dysfunction may complicate the clinical course of critically ill patients admitted to intensive care units, in the case of trauma, sepsis, neurologic disorders and cardiovascular diseases, and its occurrence adversely affects the outcome. In the care of these patients, the assessment of autonomic function may provide useful information concerning pathophysiology, risk stratification, early prognosis prediction and treatment strategies. Given the role of ANS in the maintenance of systemic homeostasis, anesthesiologists and intensivists should recognize as critical the evaluation of ANS function. Measurement of heart rate variability (HRV) is an easily accessible window into autonomic activity. It is a low‐cost, non‐invasive and simple to perform method reflecting the balance of the ANS regulation of the heart rate and offers the opportunity to detect the presence of autonomic neuropathy complicating several illnesses. The present review provides anesthesiologists and intensivists with a comprehensive summary of the possible clinical implications of HRV measurements, suggesting that autonomic dysfunction testing could potentially represent a diagnostic and prognostic tool in the care of patients both in the perioperative setting as well as in the critical care arena.

see more: http://www.gnmhealthcare.com/cgi-bin/vw.pl?a=-12&sc=1053414&c=398&us=0