Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Pharmacodynamic interaction between propofol and remifentanil regarding hypnosis, tolerance of laryngoscopy, bispectral index, and electroencephalographic approximate entropy.
The purpose of this investigation was to describe the pharmacodynamic interaction between propofol and remifentanil for probability of no response to shaking and shouting, probability of no response to laryngoscopy, Bispectral Index (BIS), and electroencephalographic approximate entropy (AE). ⋯ Remifentanil alone is ineffective at ablating response to stimuli but demonstrates potent synergy with propofol. BIS and AE values corresponding to 95% probability of ablating response are influenced by the combination of propofol and remifentanil to achieve this endpoint, with higher propofol concentrations producing lower values for BIS and AE.
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Comparative Study
Differentiating among hospitals performing physiologically complex operative procedures in the elderly.
The authors previously showed how a statewide discharge abstract database could be used to quantify for stakeholders how surgical practices differ among hospitals. The two pediatric hospitals in Iowa differ from other hospitals in Iowa based on their providing a more diverse, comprehensive, and physiologically complex selection of procedures in younger patients. Physiologically complex surgery performed in children aged 0-2 yr has been regionalized to a few high-volume facilities. ⋯ Results observed for geriatric patients provide further evidence of the validity of these methods and the usefulness of discharge abstract data for comparing surgical practices among facilities. A hospital can use discharge abstract data to assist governmental agencies, charitable organizations, philanthropists, insurers, etc., in appreciating the unique contributions of individual hospitals to surgical care.
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Singapore reported its first case of Severe Acute Respiratory Syndrome (SARS) in early March 2003 and was placed on the World Health Organization's list of SARS-affected countries on March 15, 2003. During the outbreak, Tan Tock Seng Hospital was designated as the national SARS hospital in Singapore to manage all known SARS patients. Stringent infection control measures were introduced to protect healthcare workers and control intrahospital transmission of SARS. Work-flow processes for surgery were extensively modified. ⋯ Staff personal protection, patient risk categorization, and reorganization of operating room workflow processes formed the key elements for the containment of SARS transmission. Lessons learned during this outbreak will help in the planning and execution of infection control measures, should another outbreak occur.
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Review Comparative Study
Injuries and liability related to central vascular catheters: a closed claims analysis.
To assess changing patterns of injury and liability associated with central venous or pulmonary artery catheters, the authors analyzed closed malpractice claims for central catheter injuries in the American Society of Anesthesiologists Closed Claims database. ⋯ Claims related to central catheters had a high severity of patient injury. The most common complications causing injury were wire/catheter embolus, cardiac tamponade, carotid artery puncture/cannulation, hemothorax, and pneumothorax.
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Randomized Controlled Trial Comparative Study Clinical Trial
Parental auricular acupuncture as an adjunct for parental presence during induction of anesthesia.
The purpose of this study was to determine whether parental auricular acupuncture reduces parental preoperative anxiety and thus allows children to benefit from parental presence during induction of anesthesia. ⋯ : Auricular acupuncture significantly decreased maternal anxiety during the preoperative period. Children of mothers who underwent acupuncture intervention benefitted from the reduction of maternal anxiety during the induction of anesthesia.