Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2005
The effects of platelet count on clot retraction and tissue plasminogen activator-induced fibrinolysis on thrombelastography.
Clot retraction and fibrinolysis may present as a decrease in amplitude on thrombelastography (TEG). The former represents normal or hyperactive platelet function, and the latter represents a fibrinolytic state. It is important to distinguish clot retraction from fibrinolysis because the treatment of each condition is different. ⋯ Morphological changes of clots have shown clot retraction in PRP, but not in PPP or PRP pretreated with abciximab. D-dimer levels increased only in samples to which tPA was added, but not in native PPP or PRP samples. In conclusion, we have shown that the decrease in amplitude at 30 and 60 min can be due to platelet-mediated clot retraction and can be attenuated by sample pretreatment with abciximab, which interrupts platelet-fibrin(ogen) binding.
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Pain physicians in Ohio come from many medical backgrounds and use different medical boards to claim board certification in the field of pain medicine. Our goal was to explore the number, demographics, and qualifications of pain physicians in Ohio. The names of Ohio physicians designating themselves as pain physicians were collected from the State Medical Board of Ohio and the American Medical Association. ⋯ Ninety-six (29%) of the Ohio pain physicians were certified in pain medicine by the American Board of Anesthesiology, the American Board of Physical Medicine and Rehabilitation, or the American Board of Psychiatry and Neurology, which are all member boards of the ABMS. One-hundred-seventeen (35%) of the self-declared Ohio pain physicians held no pain-related board certification. Anesthesiologists comprise the majority of all pain physicians and are the majority in all four pain boards.
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Anesthesia and analgesia · Jun 2005
The use of electrical stimulation to monitor epidural needle advancement in a porcine model.
Muscle twitches elicited with electrical stimulation (ES) during epidural insertion may indicate epidural needle location. We examined the potential application of ES at 5 mA as a continuous method of monitoring the response to epidural needle advancement in a porcine model. Five 20-kg pigs were used in this study. ⋯ Autopsies indicated there were no dural punctures or spinal cord damage in any of the pigs. These observations suggest that ES can be used to signal that the epidural needle is in or approaching the epidural space. However, the high false positive predictive value (59%) makes it impractical and unreliable to detect the precise entry of a needle into the epidural space in pigs.
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Anesthesia and analgesia · Jun 2005
Detecting unidirectional valve incompetence by the modified pressure decline method.
The 1993 Food and Drug Administration anesthesia apparatus checkout recommendation provides guidance for a standardized circle system checkout but, we believe, inadequately tests unidirectional valve (UDV) function. We developed the modified pressure decline method (MPDM) for checking UDVs. The test involves pressurizing reservoir bags downstream of the UDVs to check for competency. ⋯ One incompetent UDV (3%) was identified of the 36 valves tested in 18 anesthesia machines. The MPDM detected the valve leak (Draeger 0.6 L/min flow leak; Ohmeda 0.9 L/min flow leak) when the incompetent valve discs were intentionally introduced into each type of machine. MPDM provides a quick and effective way of identifying incompetent UDVs.