Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2007
Comparative StudyA novel supraclavicular approach to the right subclavian vein based on three-dimensional computed tomography.
We used three-dimensional (3-D) computed tomography to develop a novel supraclavicular approach to the subclavian vein that minimizes the distance from insertion site to the vein. ⋯ The proposed supraclavicular approach to the subclavian vein is a simple method of central venous catheterization. The pilot study suggests the method is reasonably safe. The video explaining the approach graphically is available in the supplementary material.
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Anesthesia and analgesia · Jul 2007
Comparative StudyOrgan toxicity and mortality in propofol-sedated rabbits under prolonged mechanical ventilation.
Prolonged administration of propofol at large doses has been implicated in propofol infusion syndrome in intensive care unit patients. In this study we investigated organ toxicity and mortality of propofol sedation at large doses in prolonged mechanically ventilated rabbits and determined the role of propofol's lipid vehicle. ⋯ Continuous infusion of 2% propofol at large doses for the sedation of rabbits undergoing prolonged mechanical ventilation induced fatal multiorgan dysfunction syndrome similar to the propofol infusion syndrome seen in humans. Our novel findings including lung, liver, gallbladder, and urinary bladder injury were also noted. The role of propofol's lipid vehicle in the manifestation of the syndrome was minor. Sevoflurane proved to be a safe alternative medication for prolonged sedation.
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Anesthesia and analgesia · Jul 2007
Comparative StudyA comparison of a new indicator-guided with a conventional wire-guided percutaneous cricothyroidotomy device in mannequins.
Percutaneous cricothyroidotomy may be a life-saving procedure in cannot intubate-cannot ventilate situations. In this study we compared the insertion times of a new indicator-guided cricothyroidotomy device and a wire-guided device in mannequins. ⋯ In a mannequin model, cricothyroidotomy insertion times were faster for the indicator-guided technique than for the wire-guided technique, but success rates were similar. Subjectively, more participants chose to use the wire-guided device in a clinical emergency situation.
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Anesthesia and analgesia · Jul 2007
Comparative StudyA simple method for deciding when patients should be ready on the day of surgery without procedure-specific data.
Deciding when patients should arrive for same-day-admission or ambulatory surgery is a problem at many hospitals and surgery centers. Although staff can often start cases earlier than scheduled, the potential start times are not known when each case is scheduled. Patient availability must therefore be balanced against patient waiting times and fasting times. Knowing the earliest time that a case might begin, given its scheduled start time, provides a rational basis for telling patients when to report for surgery and when to refrain from eating or drinking before their procedure. ⋯ We have developed a simple method for determining when patients should be ready on the day of surgery based on the start times of historical cases performed by the same surgical suite/surgical service/day of the week combination as the case of interest.
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Anesthesia and analgesia · Jul 2007
Comparative StudyAn observational study of surgeons' sequencing of cases and its impact on postanesthesia care unit and holding area staffing requirements at hospitals.
Staffing requirements in the operating room (OR) holding area and in the Phase I postanesthesia care unit (PACU) are influenced by the sequencing of each surgeon's list of cases in the same OR on the same day. ⋯ The uncoordinated decision-making of multiple surgeons working in different ORs can result in a sufficiently uniform rate of admission of patients into the PACU and holding that the independent sequencing of each surgeon's list of cases would not reduce the incidence of delays in admission or staffing requirements.