Anesthesiology
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Conventional cardiopulmonary resuscitation (CPR) includes 80-100/min precordial compressions with intermittent positive pressure ventilation (IPPV) after every fifth compression. To prevent gastric insufflation, chest compressions are held during IPPV if the patient is not intubated. Elimination of IPPV would simplify CPR and might offer physiologic advantages, but compression-induced ventilation without IPPV has been shown to result in hypercapnia. The authors hypothesized that application of continuous positive airway pressure (CPAP) might increase CO2 elimination during chest compressions. ⋯ Mechanical ventilation may not be necessary during CPR as long as CPAP is applied. Discontinuation of IPPV will simplify CPR and may offer physiologic advantage.
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Cost reduction has become an important fiscal aim of many hospitals and anesthetic departments, despite its inherent limitations. Volatile anesthetic agents are some of the few drugs that are amenable to such treatment because fresh gas flow rate (FGFR) can be independent of patient volatile anesthetic agent requirement. ⋯ Although individual feedback and education regarding volatile agent use was effective at reducing FGFR, effectiveness was reduced without continued feedback. Use of more expensive volatile agents was not reduced by education regarding drug cost, and actually increased.
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The distribution of solutions injected into the epidural space has not been determined. The author therefore examined the site of catheter tips and the spread of contrast material in the epidural space using computed tomographic (CT) imaging in patients receiving successful epidural analgesia. ⋯ A variety of catheter tip positions and patterns of solution spread underlie normal epidural anesthesia. Nonuniform distribution of injectate is common and is compatible with uniform anesthesia. Posterior midline structures play a minimal role in impeding distribution of injectate. A far lateral catheter position is a more common cause of asymmetric block than anatomic barriers to solution spread.