Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2006
Acoustic monitoring of double-lumen ventilated lungs for the detection of selective unilateral lung ventilation.
One-lung intubation (OLI) is among the most common complications of endotracheal intubation. None of the monitoring tools now available has proved effective for its early detection. In this study we investigated the efficacy of acoustic analysis for the detection of OLI. ⋯ Each respiration was classified into one of the three categories: bilateral ventilation, selective right-lung ventilation, or selective left-lung ventilation, on the basis of the ratio between the energy signals of each lung. OLI was accurately identified in 10 of the 11 patients during right OLI and in all 11 patients during left OLI. This study suggests that acoustic monitoring is effective for the detection of selective lung ventilation and may be useful for early diagnosis of OLI.
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Anesthesia and analgesia · Dec 2006
Changes in the serum proteome of patients with sepsis and septic shock.
Sepsis is still the leading cause of death in the intensive care unit. Our goal was to elucidate potential early differences in serum between survivors (SURV) and non-survivors (NON-SURV) on day 28. ⋯ Our results show that proteomic profiling is a useful approach for detecting protein expression dynamics in septic patients, and may bring us closer to achieving a comprehensive molecular profiling compared with genetic studies alone.
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Anesthesia and analgesia · Dec 2006
Case ReportsThe effect of too much intravenous lidocaine on bispectral index.
Systemic local anesthetics have beneficial perioperative properties and have an anesthetic-sparing effect. To assess depth of anesthesia during lidocaine infusion, it would be important to know the effect of systemic local anesthetics on bispectral index (BIS). ⋯ We report an inadvertent overdose of i.v. lidocaine in a patient monitored with BIS. BIS decreased to 0 for approximately 15 min, indicating that lidocaine and sevoflurane interact to decrease BIS.
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Anesthesia and analgesia · Dec 2006
Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients.
Continuous peripheral nerve block (CPNB) is an optimal choice for analgesia after orthopedic procedures, but is not commonly used in outpatients because of concern regarding the possibility of catheter-related complications. In addition, it may be difficult to provide adequate patient access to physicians in this setting. We present 620 outpatients who were treated with CPNB using an established protocol. ⋯ In this large series of outpatients treated with CPNB, there were surprisingly few interventions requiring an anesthesiologist. Likewise, patients were able to manage and remove their catheters at home without additional follow-up. This suggests that with adequate instruction and telephone access to health care providers, patients are comfortable with managing and removing CPNB catheters at home.
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Anesthesia and analgesia · Dec 2006
A system and process redesign to improve perioperative antibiotic administration.
Surgical infection is a leading cause of patient injury, mortality, and excess health care costs. As part of a collaborative effort, we instituted three main focuses for perioperative antibiotic administration: appropriate selection of antibiotics, administration of antibiotics within 60 min before incision, and discontinuation of prophylactic antibiotics within 24 h of surgery. Anesthesiologists were identified as the practitioners most likely to accomplish the successful administration of antibiotics within 60 min before incision. ⋯ Before the institution of the process, the rate of surgical site infections was 3.8%, and is now approximately 1.4%. We describe our process used to improve antibiotic administration. During this time, the surgical site infection rate has been significantly reduced.