RESUMO
OBJECTIVES: Tissue oxygen saturation (StO(2)) assessed using Near Infrared Spectroscopy and its derived parameters during a vascular occlusion test (VOT) can detect microvascular changes in septic shock patients. General anesthesia (GA) impacts microcirculation. Our aim was to study the effects of general anesthesia on StO(2) and StO(2) derived parameters obtained during VOT in patients referred for cardiac surgery. METHODS: We studied 15 patients referred for cardiac surgery before and after induction of GA. Before GA induction, we also studied 15 healthy volunteers (non patients) in order to compare baseline physiological data between patients and healthy subjects. Hemodynamic and microcirculatory (StO(2), ischemic slope, reperfusion slope, and hyperemic response) data were recorded at each step. We used the Inspectra StO(2) system (Hutchinson Inc, MN, USA) with a sensor placed on the thenar eminence. StO(2) values were obtained at baseline and during a VOT. A sphyngomanometer was placed on the forearm above the StO(2) probe and the cuff was then rapidly inflated 30 mmHg above systolic pressure and was maintained inflated until the StO(2) value reached 40%. It was then rapidly deflated. RESULTS: Healthy volunteers had significantly higher reperfusion slope than patients (348 [251-393] vs. 261 [185-279] %/min; Pâ<â0.05). GA induction induced no significant change in StO(2) value compared to baseline (79 [75-85] vs. 80 [76-86]%; P = 0.57). We observed a significant decrease in ischemic slope (from -12 [-16--8] to -8 [-10--6] %/min; P = 0.004) and in reperfusion slope (from 261 [185-279] %/min to 164 [151-222] %/min; P = 0.008) suggesting a decrease in local metabolic rate and a negative impact on reperfusion reserve induced by anesthesia. CONCLUSION: StO(2) derived parameters during a VOT are impacted by GA induction. These parameters may have potential for microcirculation assessment in patients undergoing surgery.
Assuntos
Anestesia Geral , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Oxigênio/metabolismo , Adulto , Idoso , Ponte Cardiopulmonar/efeitos adversos , Estudos de Casos e Controles , Hemodinâmica , Humanos , Masculino , Microcirculação , Oximetria/métodos , Fatores de Risco , Choque Séptico/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho/métodosRESUMO
This article discusses equine associate employment agreements from the employer's perspective. It should also be of interest to prospective equine associates. The substantive issues and questions are the same, and neither employers nor employees are likely to get far unless they "walk a mile in the other's moccasins".
Assuntos
Gestão de Recursos Humanos , Gerenciamento da Prática Profissional/organização & administração , Medicina Veterinária/organização & administração , Animais , ComunicaçãoRESUMO
When a case is referred to a specialty practice, the assumption is that the practice has the appropriate specialists, equipment, staff, and facility necessary to provide the required medical care. But what if the appropriate specialist is not available when the patient arrives?
Assuntos
Hospitais Veterinários/legislação & jurisprudência , Hospitais de Ensino/legislação & jurisprudência , Responsabilidade Legal , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Animais , Coleta de Dados , Hospitais Veterinários/normas , Hospitais de Ensino/normas , Internato e Residência/legislação & jurisprudência , Internato e Residência/normas , Admissão e Escalonamento de Pessoal/normas , Política Pública , Especialização/legislação & jurisprudência , Especialização/normas , Estados Unidos , Recursos HumanosRESUMO
In the last decade, the veterinary profession has experienced many changes, including the birth of a new area of law known as "animal law," and an increased scrutiny by the legal community and veterinary state boards. This article provides a sampling of some of the more challenging issues the profession is facing in the early part of the 21st century, namely, guardianship versus ownership, the awarding of non-economic damages in negligence lawsuits, and challenges in maintaining medical records.