Anesthesiology
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Review Meta Analysis
Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia.
Of the 4 million annual births in the United States, 2.4 million involve epidural analgesia. Serious adverse events are rare but are important in young women. Robust estimates for the risk of harm are not available. ⋯ A total of 1.37 million women received an epidural for childbirth, reported in 27 articles. Most information (85% of women) was in larger (> 10,000 women) studies published after 1990, with risk estimates as follows: epidural hematoma, 1 in 168,000; deep epidural infection, 1 in 145,000; persistent neurologic injury, 1 in 240,000; and transient neurologic injury, 1 in 6,700. Earlier and smaller studies produced significantly higher risk estimates for transient neurologic injury plus injury of unknown duration.
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Randomized Controlled Trial
Opioid-volatile anesthetic synergy: a response surface model with remifentanil and sevoflurane as prototypes.
Combining a hypnotic and an analgesic to produce sedation, analgesia, and surgical immobility required for clinical anesthesia is more common than administration of a volatile anesthetic alone. The aim of this study was to apply response surface methods to characterize the interactions between remifentanil and sevoflurane. ⋯ Response surface analyses demonstrate a synergistic interaction between remifentanil and sevoflurane for sedation and all analgesic endpoints.
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Randomized Controlled Trial Comparative Study
Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback.
The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing). ⋯ Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees. The addition of video review did not offer any advantage over oral feedback alone. Valuable simulation training can therefore be achieved even when video technology is not available.
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A fatal case of viridans streptococcus meningitis is reported, which occurred as a complication of epidural anesthesia. One hundred seventy-nine reported cases of post-dural puncture meningitis are reviewed. Evidence suggests that most cases are probably caused by contamination of the puncture site by aerosolized mouth commensals from medical personnel, some are caused from contamination by skin bacteria, and, less frequently, other cases are caused directly or hematogenously by spread from an endogenous infectious site. Controversy exists regarding prevention, surveillance, incidence, and treatment of this serious complication.
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Randomized Controlled Trial Clinical Trial
Postoperative infusion of amino acids induces a positive protein balance independently of the type of analgesia used.
Net loss of body protein is a prominent feature of the catabolic response to surgical tissue trauma. Epidural analgesia with hypocaloric dextrose has been demonstrated to attenuate leucine oxidation but was unable to make protein balance positive. The current study was set to determine whether an infusion of amino acids on the second day after colon surgery would revert the catabolic state and promote protein synthesis while maintaining glucose homeostasis in patients receiving epidural analgesia as compared with patient-controlled analgesia with morphine (PCA). ⋯ Infusion of amino acids decreased the endogenous glucose production and induced a positive protein balance independent of the type of anesthesia provided, although such effects were greater in the PCA group.