Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2006
Comparative StudyCraniocervical extension improves the specificity and predictive value of the Mallampati airway evaluation.
The modified Mallampati (MMP) classification is a standard airway examination that assesses mouth opening and structures within the oral cavity. Recent data suggest that maximal mouth opening (as measured by interdental distance) is possible only with extension of the craniocervical junction. Because the MMP examination is performed with the head in a neutral position, the airway may appear worse because of submaximal interdental distance. We hypothesized that adding craniocervical extension to the MMP would allow for greater mouth opening, lower scores, and less false positives than the traditional MMP examination. ⋯ Craniocervical extension improves the specificity and positive predictive value of the MMP airway evaluation while retaining sensitivity of the traditional MMP examination. The introduction of the EMS into clinical practice should be considered.
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Anesthesia and analgesia · Nov 2006
ReviewVagal nerve stimulation: overview and implications for anesthesiologists.
Vagal nerve stimulation is an important adjunctive therapy for medically refractory epilepsy and major depression. Additionally, it may prove effective in treating obesity, Alzheimer's disease, and some neuropsychiatic disorders. ⋯ In this review, we will focus on the indications for vagal nerve stimulation (both approved and experimental), proposed therapeutic mechanisms for vagal nerve stimulation, and potential perioperative complications during initial VNS placement. Anesthetic considerations during initial device placement, as well as anesthetic management issues for patients with a preexisting VNS, are reviewed.
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Anesthesia and analgesia · Nov 2006
ReviewThe problem of artifacts in patient monitor data during surgery: a clinical and methodological review.
Artifacts are a significant problem affecting the accurate display of information during surgery. They are also a source of false alarms. A secondary problem is the inadvertent recording of artifactual and inaccurate information in automated record keeping systems. ⋯ Methods adopted by currently marketed patient monitors to eliminate and minimize artifacts due to technical and environmental factors are reviewed and discussed. Also discussed are promising artifact detection and correction methods that are being investigated. These might be used to detect and eliminate artifacts with improved accuracy and specificity.