Anesthesiology
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Administering anesthesia is a complex task in which either human or equipment failure can have disastrous consequences. An improved understanding of the nature of the anesthesiologist's job could provide a more rational basis for improvements in provider training as well as the design of anesthesia equipment. The objective of this study was to develop a set of techniques to evaluate anesthesiologist performance and to determine what information could be obtained from performing real-time task assessment and workload analysis tests in the operating room. ⋯ These techniques permitted an objective description of task characteristics, workload, and vigilance in anesthesia personnel under actual work conditions. This methodology could aid in understanding the factors that affect anesthesiologists' performance and may prove useful in assessing the progress of training.
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It has been suggested that the liver may be at risk for ischemic damage during adenosine-induced hypotension. This notion, however, is somewhat inconsistent with the understanding that adenosine is a powerful vasodilator of the splanchnic circulation. To help clarify the effect of adenosine-induced hypotension on splanchnic hemodynamics, we studied the systemic and splanchnic hemodynamic responses to adenosine, both alone and in the presence of halothane or sevoflurane. ⋯ These findings demonstrate that adenosine is a potent vasodilator of portal tributary and hepatic arterial vasculature in the rat and that the splanchnic hemodynamic effects of adenosine predominate over those of halothane and sevoflurane.
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The results of sevoflurane biotransformation (fluoromethyl-1,1,1,3,3,3,-hexafluoro-2-propyl ether) to inorganic fluoride have been examined. However, these investigations have lacked a simplified assay for determining the primary organic metabolite, hexafluoroisopropanol. Previous attempts have involved extensive extraction steps, complicated derivatization techniques, or sophisticated detectors. ⋯ This simplified approach does not require the extraction, derivatization, or mass spectrometric detectors of previous methods. As sevoflurane utilization and research increases, this assay should allow for a variety of laboratory and clinical disposition studies to be performed.
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Sevoflurane reacts with CO2 absorbents, resulting in the generation of breakdown products. The concentrations of sevoflurane breakdown products in a low-flow system within 5 h have been reported, but concentrations in low-flow anesthesia exceeding 5 h or in closed-circuit anesthesia have not. In this study, the breakdown products of sevoflurane in closed-circuit anesthesia exceeding 5 h were examined. ⋯ Two breakdown products were detected in the patients anesthetized with sevoflurane using a closed-circuit technique. No abnormalities were observed during anesthesia, and no evidence of hepatic or renal dysfunction was noted in postoperative laboratory tests.