Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2008
Comparative StudyAdvanced auditory displays and head-mounted displays: advantages and disadvantages for monitoring by the distracted anesthesiologist.
In a full-scale anesthesia simulator study we examined the relative effectiveness of advanced auditory displays for respiratory and blood pressure monitoring and of head-mounted displays (HMDs) as supplements to standard intraoperative monitoring. ⋯ Advanced auditory displays help the distracted anesthesiologist maintain peripheral awareness of a simulated patient's status, whereas a HMD does not significantly improve performance. Further studies should test these findings in other intraoperative contexts.
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Anesthesia and analgesia · Jun 2008
Comparative StudyRight- and left-sided Mallinckrodt double-lumen tubes have identical clinical performance.
Left-sided double-lumen tubes are perceived to be safer than right-sided tubes, because they may be less prone to malposition. If this is true, then the incidence and severity of hypoxemia, hypercapnea, and high airway pressures should be higher for right-sided tubes during thoracic surgery than for left-sided tubes. ⋯ The supposition that left-sided double-lumen tubes are safer than right-sided tubes when intraoperative hypoxemia, hypercapnea, and high airway pressures are used as criteria for safety is not supported by our data comparing the two types of tubes from one manufacturer.
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Anesthesia and analgesia · Jun 2008
Teaching and evaluating group competency in systems-based practice in anesthesiology.
Teaching and assessment of the systems-based practice competency has been problematic in hospital-based specialties such as anesthesiology. We developed a method to teach systems-based practice with collaborative team projects. The outcome was assessed with a tool that focused on group attributes. ⋯ We developed an innovative method to teach systems-based practice through a team-based project initiative. The projects appear to have had a positive impact on our health care organization. Our assessment tool for the project evaluated team, rather than individual, performance, which is crucial in this competency.
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Anesthesia and analgesia · Jun 2008
The analgesic drug, tramadol, acts as an agonist of the transient receptor potential vanilloid-1.
Tramadol is an effective analgesic substance widely used in medical practice. Its therapeutic action have been mainly attributed to the activation of mu-opioid receptors as well as to the inhibition of neurotransmitter reuptake mechanisms and various voltage- and ligand-gated ion channels of the nociceptive system. As transient receptor potential vanilloid-1 (TRPV1, "the capsaicin receptor") has been shown to function as a central integrator molecule of pain sensation, our aim in the current study was to define the involvement of TRPV1 in the complex mechanism of action of tramadol. ⋯ Collectively, these findings strongly support the intriguing and novel concept that tramadol acts as an agonist of TRPV1. Considering that activation of TRPV1 on sensory neurons is followed by a local release of vasoactive neuropeptides and a marked desensitization of the afferent fibers (hence termination of pain sensation), our findings may equally explain both the desired analgesic as well as the often-seen, yet "unexpected," local side effects (e.g., initiation of burning pain and erythema) of tramadol.
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Anesthesia and analgesia · Jun 2008
Case ReportsMigraine with atypical aura in the recovery room: a sometimes complicated diagnosis!
Migraine is a frequent neurological pathology. However, the diagnosis can be difficult to establish, especially when it is accompanied with an atypical aura that can be confounded with a stroke. ⋯ The patient had not mentioned migraine in her history before the surgery. This lack of information led to unnecessary therapy.