Clinical Adult Literature Updates from September 2012

Orexin-A Facilitates Emergence from Propofol Anesthesia in the Rat

In rats, c-FOS positive (i.e. “active”) orexinergic neurons were reduced during propofol anesthesia, and restored during emergence. Microinjection of orexin-A into the basal forebrain caused a reduction in burst suppression ratio on EEG, and reduced time to emergence from propofol anesthesia. These results suggest that activation of orexinergic signaling plays a role in emergence from propofol anesthesia.

Role of Interleukin-6 in Stress, Sleep, and Fatigue

This review summarizes the published literature on the links between elevations of pro-inflammatory cytokine IL-6 and sleep and vice-versa.

Altered Sleep and Affect in the Neurotensin Receptor 1 Knockout Mouse

This work presents further evidence of the genetic component (expression of Ntsr1 gene) implicated in the regulation of both sleep and mood disorders.

Extracellular Levels of Lactate, but Not Oxygen, Reflect Sleep Homeostasis in the Rat Cerebral Cortex

This study presents a very elegant work that shows a role for glycolytic processes in sleep homeostasis.

Unplanned Admission After Day Surgery: A Historical Cohort Study in Patients with Obstructive Sleep Apnea

The rate of unplanned admission was 7.0% (95% confidence interval [CI] 5.1 to 8.9) in OSA patients compared with 5.6% (95% CI 4.1 to 7.1) in patients without OSA (odds ratio 1.26; 95% CI 0.83 to 1.91; P = 0.246). Median [interquartile range; IQR] hospital length of stay was 7 hr [IQR 5, 8] with OSA and 6 hr [IQR 5, 8] without OSA (P = 0.058). Severity of OSA was not associated with unplanned admission. They did not identify a clinically important increased rate of unplanned admission associated with a prior diagnosis of OSA.

Noninvasive Positive-Pressure Ventilation (NPPV) for Acute Respiratory Failure [Internet]

This study is a systematic review of the literature on the role of Noninvasive positive-pressure ventilation (NPPV) in the setting of acute respiratory failure. Reviewing more than 50 studies, the author concluded that for patients with acute respiratory failure due to severe exacerbations of COPD or congestive heart failure, NPPV improves outcomes compared to supportive care alone.

Pulmonary Complications After Elective Liver Transplantation-Incidence, Risk Factors, and Outcome

The postoperative clinical course of 212 liver transplant recipients between January 2008 and April 2010 was analyzed. Pneumonia was the most common complication among patients undergoing liver transplants and was a major cause of morbidity. A restrictive pattern on preoperative pulmonary testing and a higher international normalized ratio measured prior to surgery were associated with higher risk of postoperative pneumonia.

Total Joint Arthroplasty in Patients with Obstructive Sleep Apnea: Strategies for Reduction of Perioperative Complications

The authors of this study report on their institution’s efforts to employ postoperative precautions for OSA patients in an effort to minimize the impact of postoperative complications in this group. They conclude that their “postoperative monitoring protocols are successful in reducing postoperative complications most commonly associated with OSA.

Respiratory Perioperative Management of Patients With Obstructive Sleep Apnea

Perioperative management of a patient with OSA should be modified and may include regional anesthesia and alternative analgesic techniques such as nonsteroidal anti-inflammatory drugs that may reduce the need for systemic opioids. Additionally, supplemental O2 and continuous pulse oximetry monitoring should be utilized to maintain baseline O2 saturation. Postoperatively patients should remain in a semi-upright position and positive pressure therapy should be used in patients with high-risk OSA.