Anesthesiology
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Comparative Study
Neurally adjusted ventilatory assist increases respiratory variability and complexity in acute respiratory failure.
Neurally adjusted ventilatory assist (NAVA) is a partial ventilatory support mode where positive pressure is provided in relation to diaphragmatic electrical activity (EAdi). Central inspiratory activity is normally not monotonous, but it demonstrates short-term variability and complexity. The authors reasoned that NAVA should produce a more "natural" or variable breathing pattern than other modes. This study compared respiratory variability and complexity during pressure support ventilation (PSV) and NAVA. ⋯ Compared with PSV, NAVA increases the breathing pattern variability and complexity of flow, whereas the complexity of EAdi is unchanged. Whether this improves clinical outcomes remains to be determined.
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Selective serotonin reuptake inhibitors have been associated with an increased bleeding tendency. Information on the impact of a possible impaired hemostasis associated with the perioperative use of selective serotonin reuptake inhibitors is limited. This study aimed to determine the association between the perioperative use of selective serotonin reuptake inhibitors and the amount of blood loss during surgery and perioperative transfusion requirements. ⋯ Patients undergoing total hip arthroplasty who continue the use of serotonergic antidepressants show a significantly higher, but clinically unimportant, intraoperative blood loss, without an increase in perioperative transfusion requirements.
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Multicenter Study
Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study.
Medical errors exact an inordinate toll on healthcare costs. One of the most publicized and analyzed type of medical error is wrong-site surgery. Yet, despite the burgeoning number of procedures performed, no literature exists on wrong-site pain management injections. The purpose of this study was to estimate the relative incidence and determine the causes of wrong-site pain management procedures. ⋯ Wrong-site nerve blocks occur more frequently in pain management centers than has previously been acknowledged. Adaptation of the universal protocol to nerve blocks and strict adherence to widely accepted guidelines may prevent wrong-site interventional pain procedures.
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Coronary revascularization of the suspected culprit coronary lesion assessed by preoperative stress testing is not associated with improved outcome in vascular surgery patients. ⋯ There was a poor correlation between the locations of preoperatively assessed stress-induced NWMAs by dobutamine echocardiography and those observed intraoperatively using transesophageal echocardiography. However, the composite endpoint of outcome was met more frequently in relation with intraoperative NWMAs.