Anesthesia and analgesia
-
Anesthesia and analgesia · Dec 2007
Comparative StudyNew circulating-water devices warm more quickly than forced-air in volunteers.
Newer circulating-water systems supply more heat than forced-air, mainly because the heat capacity of water is much greater than for that of dry warm air and, in part, because they provide posterior as well as anterior heating. Several heating systems are available, but three major ones have yet to be compared directly. We therefore compared two circulating-water systems with a forced-air system during simulation of upper abdominal or chest surgery in volunteers. ⋯ The warming rate with the Kimberly Clark system was 25% faster than with the Allon system and twice as fast as with the Bair Hugger. Both circulating-water systems thus warmed hypothermic volunteers in significantly less time than the forced-air system.
-
Anesthesia and analgesia · Dec 2007
Comparative StudyThe analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments.
Immersive virtual reality (VR) is a novel form of distraction analgesia, yet its effects on pain-related brain activity when used adjunctively with opioid analgesics are unknown. We used subjective pain ratings and functional magnetic resonance imaging to measure pain and pain-related brain activity in subjects receiving opioid and/or VR distraction. ⋯ These subjective pain reports and objective functional magnetic resonance imaging results demonstrate converging evidence for the analgesic efficacy of opioid administration alone and VR distraction alone. Furthermore, patterns of pain-related brain activity support the significant subjective analgesic effects of VR distraction when used as an adjunct to opioid analgesia. These results provide preliminary data to support the clinical use of multimodal (e.g., combined pharmacologic and nonpharmacologic) analgesic techniques.
-
Anesthesia and analgesia · Dec 2007
Comparative StudyAn experimental and clinical evaluation of a novel central venous catheter with integrated oximetry for pediatric patients undergoing cardiac surgery.
Central venous oxygen saturation (ScvO2) accurately reflects cardiocirculatory function, but is not always feasible in pediatric patients. Using an experimental and clinical approach, we determined the accuracy of a novel pediatric central venous catheter with integrated fiberoptic oximetry, correlated ScvO2 to periprocedural vital variables, and tested its feasibility in pediatric cardiac surgery patients. ⋯ Integrated central venous oximetry catheters provide accurate continuous ScvO2 monitoring in pediatric patients undergoing cardiac surgery. ScvO2 fiberoptic oximetry correlates better with changes in CI as compared to routine hemodynamic variables.
-
Anesthesia and analgesia · Dec 2007
Comparative StudyCoordination of appointments for anesthesia care outside of operating rooms using an enterprise-wide scheduling system.
An anesthesia department implemented scheduling of anesthetics outside of operating rooms (non-OR) by clerks and nurses from other departments using its hospital's enterprise-wide scheduling system. ⋯ Enterprise-wide scheduling can coordinate anesthetics with other appointments on the same date and improve consistency and accuracy of patient instructions customized to the probability of an anesthetic starting early. The usefulness of implementation depends on the value in having more patient-centered care and/or in having patients arrive just in time for non-OR anesthesia, surgery, or regional block placement (e.g., at facilities with limited physical space).
-
Anesthesia and analgesia · Dec 2007
Comparative StudyReference values for kaolin-activated thromboelastography in healthy children.
The hemostatic system of children changes with age and differs significantly from the hemostatic system of adults. Age-specific reference values are therefore required for most hemostatic variables. Thromboelastography (TEG) is a point-of-care coagulation test that may provide superior evaluation and management of coagulopathies after cardiac surgery, when large-dose unfractionated heparin is administered for cardiopulmonary bypass. In this study, we established reference values for kaolin-activated TEG in healthy children, to facilitate accurate interpretation of pediatric TEG results. ⋯ TEG results, from a particular clinical setting, must be compared to age-specific, as well as analyzer- and activator-specific, reference values to allow for correct interpretation of the results. Reference values provided here will be of use in acute clinical situations where a practical monitor of hemostasis is required.