Anesthesiology
-
Invasive procedures such as epidural anesthesia carry risks for complications such as erroneous placement arising from inadequate manual skills and infection secondary to breaches in aseptic technique. Although it is assumed that improvement in aseptic technique parallels improved dexterity, this assertion remains unproven. The aim of this study was to determine whether increased proficiency in the manual skills for epidural anesthesia is associated with improved aseptic technique. ⋯ Manual skills for invasive procedures improved with increasing experience, but aseptic technique did not, despite formal teaching. These findings reflect major gaps in the understanding and teaching of the principles of aseptic technique, most likely due to lack of structured training. Educational initiatives are needed to correct these teaching gaps.
-
Autonomic hyperreflexia (AHR) is a potentially life-threatening hypertensive condition that occurs in patients with high spinal cord injury (SCI). The current study was aimed to determine sevoflurane concentrations that block AHR in SCI patients. ⋯ The EC95 for sevoflurane in 50% nitrous oxide to block AHR during transurethral litholapaxy in patients with SCI was 3.83%.
-
Hemodynamic responses to spinal anesthesia (SA) for cesarean delivery in patients with severe preeclampsia are poorly understood. This study used a beat-by-beat monitor of cardiac output (CO) to characterize the response to SA. The hypothesis was that CO would decrease from baseline values by less than 20%. ⋯ Spinal anesthesia in severe preeclampsia was associated with clinically insignificant changes in CO. Phenylephrine restored mean arterial pressure but did not increase maternal CO. Oxytocin caused transient marked hypotension, tachycardia, and increases in CO.
-
Growth pattern in the electroencephalographic bicoherence spectrum has recently been found to relate to anesthetic depth, and bicoherence analysis can reflect behavior of the thalamocortical reverberating network. Because the thalamocortical network is known to represent a key factor in sleep by anesthesia, systematic and qualitative bicoherence studies of different anesthetic depths is necessary throughout all pairs of frequencies. ⋯ Sevoflurane anesthesia caused bicoherence peaks in alpha and delta-theta areas and also formed secondary third peaks. Deeper sevoflurane anesthesia shifted all bicoherence peaks to lower frequencies and caused increased bicoherence growth in the delta-theta area. The obtained features are consistent with characteristics of the thalamocortical reverberating network and suggest the importance of bicoherence analysis for the thalamic system.
-
In pediatric patients, the Bispectral Index (BIS), derived from the electroencephalogram, and the composite A-Line autoregressive index (cAAI), derived from auditory evoked potentials and the electroencephalogram, have been used as measurements of depth of hypnosis during anesthesia. The performance and reliability of BIS and cAAI in distinguishing different hypnotic states in children, as evaluated with the University of Michigan Sedation Scale, were compared. ⋯ BIS and cAAI were comparable indicators of depth of hypnosis in children. Both indices, however, showed considerable overlap for different clinical conditions.