Anesthesiology
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Randomized Controlled Trial
Intra- and Interrater Reliability of Ultrasound Assessment of Gastric Volume.
Gastric sonography can provide information about gastric content and volume that can help determine aspiration risk at the bedside. The primary objective of this study is to assess the intrarater and interrater reliability of a previously validated method of gastric volume assessment based on gastric antral area. The secondary objective is to evaluate the agreement between two different methods to measure gastric antral area. ⋯ Ultrasound assessment of gastric volume by clinical anesthesiologists is highly reproducible with high intrarater and interrater reliability. The free-tracing method to measure antral cross-sectional area is equivalent to the two-diameter method.
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Mechanical ventilation (MV) is a life-saving intervention in patients with acute respiratory failure. However, prolonged MV results in ventilator-induced diaphragm dysfunction (VIDD), a condition characterized by both diaphragm fiber atrophy and contractile dysfunction. Previous work has shown that calpain, caspase-3, and the ubiquitin-proteasome pathway (UPP) are all activated in the diaphragm during prolonged MV. However, although it is established that both calpain and caspase-3 are important contributors to VIDD, the role that the UPP plays in the development of VIDD remains unknown. These experiments tested the hypothesis that inhibition of the UPP will protect the diaphragm against VIDD. ⋯ Collectively, these results indicate that proteasome activation does not play a required role in VIDD development during the first 12 h of MV.
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Precise estimates of final operating room demand can only be made 1 or 2 days before the day of surgery, when it is harder to adjust staffing to match demand. The authors hypothesized that the accumulating elective schedule contains useful information for predicting final case demand sufficiently in advance to readily adjust staffing. ⋯ The developing elective schedule predicts final case volume weeks in advance. After implementation, overly high- or low-volume days are revealed in advance, allowing nursing, ancillary service, and anesthesia managers to proactively fine-tune staffing up or down to match demand.