Anesthesiology
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Obstetrics carries high medical liability risk. Maternal death and newborn death/brain damage were the most common complications in obstetric anesthesia malpractice claims before 1990. As the liability profile may have changed over the past two decades, the authors reviewed recent obstetric claims in the American Society of Anesthesiologists Closed Claims database. ⋯ Newborn death/brain damage has decreased, yet it remains a leading cause of obstetric anesthesia malpractice claims over time. Potentially preventable anesthetic causes of newborn injury included delays in anesthesia care and poor communication between the obstetrician and anesthesiologist.
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Comparative Study
Laryngoscopy via Macintosh blade versus GlideScope: success rate and time for endotracheal intubation in untrained medical personnel.
Tracheal intubation is the preferred technique to secure the airway and apply mechanical ventilation. However, when performed by untrained medical personnel, tracheal intubation via direct laryngoscopy has a high rate of failure. The GlideScope (Verathon Medical Europe, Ijsselstein, Netherlands) technique improves the success rate for difficult tracheal intubation performed by experienced physicians; whether this technique improves the success rate for normal intubations when performed by inexperienced personnel as well is unknown. Therefore, the authors compared the success rate of direct laryngoscopy versus the GlideScope technique performed by personnel inexperienced in tracheal intubations. ⋯ Tracheal intubation is the preferred technique to secure the airways in patients with a high risk of aspiration and is important in emergency medicine. Direct laryngoscopy with the Macintosh blade has a success rate of only 51% in our subjects. Using the GlideScope technique, a success rate of more than 90% within 120 s can be achieved after the first attempt, even in personnel untrained in intubation.
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Comparative Study
Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery.
The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data. ⋯ In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.
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Comparative Study
Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery.
Delirium is an acute deterioration of brain function characterized by fluctuating consciousness and an inability to maintain attention. Use of statins has been shown to decrease morbidity and mortality after major surgical procedures. The objective of this study was to determine an association between preoperative administration of statins and postoperative delirium in a large prospective cohort of patients undergoing cardiac surgery with cardiopulmonary bypass. ⋯ Preoperative administration of statins is associated with the reduced risk of postoperative delirium after cardiac surgery with cardiopulmonary bypass.