Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2009
Monitoring with head-mounted displays: performance and safety in a full-scale simulator and part-task trainer.
Head-mounted displays (HMDs) can help anesthesiologists with intraoperative monitoring by keeping patients' vital signs within view at all times, even while the anesthesiologist is busy performing procedures or unable to see the monitor. The anesthesia literature suggests that there are advantages of HMD use, but research into head-up displays in the cockpit suggests that HMDs may exacerbate inattentional blindness (a tendency for users to miss unexpected but salient events in the field of view) and may introduce perceptual issues relating to focal depth. We investigated these issues in two simulator-based experiments. ⋯ The HMD helped anesthesiologists detect events when physically constrained, but not when physically unconstrained. Although there was no conclusive evidence of worsened inattentional blindness, found in aviation, the perceptual properties of the HMD display appear to influence whether events are detected. Anesthesiologists wearing HMDs should self-adjust the focus to minimize eyestrain and should be aware that some changes may not attract their attention. Future areas of research include developing principles for the design of HMDs, evaluating other types of HMDs, and evaluating the HMD in clinical contexts.
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In this article, we analyze myopathies with cores, for which an association to malignant hyperthermia (MH) has been suggested. We discuss the clinical features, the underlying genetic defects, subsequent effects on cellular calcium metabolism, and in vitro muscle responses to MH triggers. We describe in detail central core disease, multiminicore disease, and nemaline rod myopathy. We categorize the diseases according to the affected proteins and discuss the risk for MH, which is high or theoretically possible when the calcium-conducting proteins are affected.
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Anesthesia and analgesia · Oct 2009
Comparative StudyAn analysis of drug delivery dynamics via a pediatric central venous infusion system: quantification of delays in achieving intended doses.
Pediatric patients frequently receive continuous infusions of drugs via central venous catheters in the intensive care unit and the operating room. This study characterized drug delivery profiles in a quantitative laboratory model of a standard pediatric central venous infusion system. ⋯ Current infusion techniques in the pediatric care setting can result in significant, unrecognized, and potentially hazardous delays in achieving delivery of intended drug doses to the patient. Total flow rate, priming of the infusion system, the dead volume of the fluid path, and the start-up performance of the infusion pump system contribute to delays in achieving targeted rates of drug delivery.
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Anesthesia and analgesia · Oct 2009
Clinical TrialFractal cardiovascular dynamics and baroreflex sensitivity after stellate ganglion block.
It has been shown that stellate ganglion block can attenuate baroreflex sensitivity. Our primary purpose in this study was to determine whether fractal dynamics (dynamic change of self-similar fluctuation patterns) of not only heart rate but also systolic blood pressure variability are involved in attenuation of baroreflex sensitivity after stellate ganglion block. ⋯ Loss of complexity (status of being complex behavior) of both heart rate and systolic blood pressure variability, indicated by increased fractal slopes, is one mechanism in attenuating baroreflex sensitivity after stellate ganglion block.
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Anesthesia and analgesia · Oct 2009
Comparative StudyThe relative exposure of the operating room staff to sevoflurane during intracerebral surgery.
Our primary aim in this study was to investigate whether escape of the volatile anesthetic sevoflurane from the surgical site during craniotomy for tumor resection increases the exposure of the neurosurgeon to the anesthetic when compared with the anesthesiologist. ⋯ The close proximity of the surgeon's breathing zone to the craniotomy window does not appear to be a source of increased exposure to sevoflurane. The observed higher exposure of the anesthesiologist to sevoflurane in the operating room environment warrants further exploration.