Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2004
Case ReportsRigid bronchoscope-assisted endotracheal intubation: yet another use of the gum elastic bougie.
We describe a technique by which a gum elastic bougie (GEB) is used to facilitate an anticipated difficult endotracheal intubation in a patient undergoing rigid bronchoscopy. After placing the GEB through the lumen of the rigid bronchoscope, the GEB-suction catheter assembly was used to safely withdraw the bronchoscope in a manner mimicking the withdrawal of an intubating laryngeal mask airway (LMA) over the endotracheal tube using a stabilizer rod. The rationale for management and potential advantages of this approach versus use of an airway exchange catheter (including increased stability of an intubation guide) are discussed. ⋯ We describe a technique of using a gum elastic bougie to facilitate an endotracheal intubation in a patient undergoing rigid bronchoscopy, which can be useful in a variety of clinical situations when the rigid bronchoscope is used in patients with abnormal airway.
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Anesthesia and analgesia · Feb 2004
Case ReportsThe presence of working memory without explicit recall in a critically ill patient.
We describe an intubated patient sedated with propofol who interacted with caregivers, demonstrating intact "working memory." When neuromuscular blockade and bispectral index (BIS) monitoring were instituted, a greatly reduced amount of sedative achieved BIS values less than 60. Neither the sedation that allowed working memory nor the lighter sedation that produced BIS values less than 60 resulted in recall. This experience suggests that working memory demonstrated when BIS values are less than 60 is unlikely to lead to recall. ⋯ The presence of intact working memory during sedation is a poor predictor of explicit recall when bispectral index values are maintained less than 60.
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Anesthesia and analgesia · Feb 2004
Resident training level and quality of anesthesia care in a university hospital.
In this study, we analyzed the relationship between resident training and patient safety in anesthesia. A retrospective quality improvement database review was used to calculate the relative risk of any quality problem and specific types of quality problems (injury, escalation of care, or operational inefficiency) between anesthesia teams with CA1, CA2, and CA3 residents. It was expected that teams with less experienced residents (CA1) would have more frequent quality problems than teams with more experienced residents (CA2 and CA3 teams). Data showed that risk of injury did not differ between CA1, CA2, and CA3 teams. CA2 teams had higher rates of critical incidents and escalation of care than CA1 and CA3 teams and higher rates of operational inefficiency than CA3 teams. The CA2 yr is when residents move into specialty training, requiring more advanced skills and a larger knowledge base. Their higher relative risk for critical incidents, escalation of care, and operational inefficiencies may reflect lack of experience, uncertainty, and less skill mastery compared with CA3 residents. The higher inefficiency and escalation of care rates associated with CA2 teams may translate into larger costs for the institution. ⋯ Appropriate supervision of anesthesia residents helps to ensure patient safety. Anesthesia management problems are most common during the CA2 yr and result in higher costs for the institution.
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Anesthesia and analgesia · Feb 2004
Meloxicam, a specific COX-2 inhibitor, does not enhance the isoflurane minimum alveolar concentration reduction produced by morphine in the rat.
A synergistic effect of nonselective cyclooxygenase (COX) inhibitors on morphine-induced decrease of isoflurane minimum alveolar concentration (MAC(ISO)) has been observed in the rat. We studied the influence of specific COX-2 inhibitors on this decrease of MAC. Sixty-four female rats were anesthetized with isoflurane in oxygen. The animals were grouped into saline solution, aspirin (30 mg/kg), morphine (1 mg/kg), morphine (1 mg/kg) + aspirin (30 mg/kg), meloxicam (1 and 3 mg/kg), and morphine (1 mg/kg) + meloxicam (1 and 3 mg/kg). Then the MAC(ISO) was determined from alveolar gas samples at the time of tail clamp. The groups treated with saline solution, aspirin, and 1 and 3 mg/kg meloxicam did not express any statistically relevant changes among them. The administration of morphine + meloxicam 1 or 3 mg/kg significantly reduced the MAC(ISO) just as in the group where only morphine was administered (morphine 1.35% +/- 0.07%, morphine + 1 mg/kg meloxicam 1.36% +/- 0.04%, and morphine + 3 mg/kg meloxicam 1.37% +/- 0.08%). The greatest reduction of MAC(ISO) was after administration of morphine + aspirin (1.19% +/- 0.05%). The administration of meloxicam does not potentiate the morphine-induced decrease of MAC(ISO) in the rat. ⋯ A synergistic effect between morphine and aspirin on isoflurane minimum alveolar concentration has been observed in the rat--an effect that does not occur between morphine and meloxicam.