Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2021
The Effect of Carbetocin Dose on Transmural Dispersion of Myocardial Repolarization in Healthy Parturients Scheduled for Elective Cesarean Delivery Under Spinal Anesthesia: A Prospective, Randomized Clinical Trial.
QT interval prolongation is associated with torsade de pointes but remains a poor predictor of drug torsadogenicity. Increased transmural dispersion of myocardial repolarization (TDR), measured as the time interval between the peak and end of the T wave (Tp-e), is a more reliable predictor. Carbetocin is recommended as an uterotonic in patients undergoing cesarean delivery (CD), but its effect on Tp-e is unknown. We evaluated the effect of carbetocin dose on Tp-e and Bazett-corrected QT intervals (QTc) during elective CD under spinal anesthesia. ⋯ Tp-e was unaffected by C50 IV given after CD in healthy parturients under spinal anesthesia, but minimally prolonged by C100. The increase in QTc after carbetocin administration was statistically significant, but with no apparent dose-dependent effect. The minimal Tp-e prolongation at the higher dose is unlikely to have any clinically significant impact on TDR and therefore the risk of inducing torsade de pointes is low.
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Anesthesia and analgesia · Feb 2021
Successful Implementation of a Perioperative Data Warehouse Using Another Hospital's Published Specification From Epic's Electronic Health Record System.
Many hospitals have replaced their legacy anesthesia information management system with an enterprise-wide electronic health record system. Integrating the anesthesia data within the context of the global hospital information infrastructure has created substantive challenges for many organizations. A process to build a perioperative data warehouse from Epic was recently published from the University of California Los Angeles (UCLA), but the generalizability of that process is unknown. We describe the implementation of their process at the University of Miami (UM). ⋯ The data schema developed at UCLA proved to be a practical and scalable method to extract information from the Epic electronic health system database into the perioperative data warehouse in use at UM. Implementing the process developed at UCLA to build a comprehensive perioperative data warehouse from Epic is an extensible process that other hospitals seeking more efficient access to their electronic health record data should consider.
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Anesthesia and analgesia · Feb 2021
A Positive Cocaine Urine Toxicology Test and the Effect on Intraoperative Hemodynamics Under General Anesthesia.
Cocaine has a short biological half-life, but inactive urine metabolites may be detectable for a week following use. It is unclear if patients who test positive for cocaine but have a normal electrocardiogram and vital signs have a greater percentage of hemodynamic events intraoperatively. ⋯ Asymptomatic cocaine-positive patients undergoing elective noncardiac surgery under general anesthesia have similar percentages of intraoperative hemodynamic events compared to cocaine-negative patients.
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Anesthesia and analgesia · Feb 2021
Acute Kidney Injury and Outcomes in Children Undergoing Noncardiac Surgery: A Propensity-Matched Analysis.
Acute kidney injury (AKI) has been well documented in adults after noncardiac surgery and demonstrated to be associated with adverse outcomes. We report the prevalence of AKI after pediatric noncardiac surgery, the perioperative factors associated with postoperative AKI, and the association of AKI with postoperative outcomes in children undergoing noncardiac surgery. ⋯ In children undergoing noncardiac surgery, postoperative AKI occurred in 3.2% of patients. Several factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models. After adjustment, only ASA status was found to be significantly associated with AKI in children after noncardiac surgery. Postoperative AKI was found to be associated with significantly higher rates of mortality and 30-day readmission in multivariable, time-varying models with propensity-matched controls.