Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2009
Redesign of a university hospital preanesthesia evaluation clinic using a queuing theory approach.
Changes in patient length of stay (the duration of 1 clinic visit) as a result of the introduction of an electronic patient file system forced an anesthesia department to change its outpatient clinic organization. In this study, we sought to demonstrate how the involvement of essential employees combined with mathematical techniques to support the decision-making process resulted in a successful intervention. ⋯ Queuing theory provides robust methods to evaluate alternative designs for the organization of PACs. In this article, we show that queuing modeling is an adequate approach for redesigning processes in PACs.
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Anesthesia and analgesia · Nov 2009
The reproducibility of Stewart parameters for acid-base diagnosis using two central laboratory analyzers.
Acid-base derangements can be interpreted using the Stewart-Fencl approach, which includes calculation of the apparent strong ion difference (SID(app)), the effective SID (SID(eff)), and the strong ion gap (SIG). These calculations require the measurement of several variables. We hypothesized that the SID and SIG calculated by different analyzers would not be reproducible because of variability in the measured values. ⋯ The results of the Stewart-Fencl approach for interpretation of acid-base status can vary according to the analyzer used. These differences may have important clinical and research implications..
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Anesthesia and analgesia · Nov 2009
The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients.
N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts adverse cardiac outcome in patients undergoing vascular surgery. However, several conditions might influence this prognostic value, including anemia. In this study, we evaluated whether anemia confounds the prognostic value of NT-proBNP for predicting cardiac events in patients undergoing vascular surgery. ⋯ Both anemia and NT-proBNP are independently associated with an increased risk for postoperative cardiac events in patients undergoing vascular surgery. NT-proBNP has less predictive value in anemic patients.
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Anesthesia and analgesia · Nov 2009
Inotropic support during experimental endotoxemic shock: part I. The effects of levosimendan on splanchnic perfusion.
Septic shock may cause splanchnic hypoperfusion. We hypothesized that levosimendan would improve systemic and hepatosplanchnic perfusion during endotoxemic shock. ⋯ Levosimendan administered after the establishment of endotoxemic shock to pigs receiving moderate fluid resuscitation prevented further increases in MPAP and maintained a low SVR. There were, however, no improvements in CO, MAP decreased, and levosimendan neither prevented the development of circulatory shock nor improved hepatosplanchnic perfusion.
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Anesthesia and analgesia · Nov 2009
Ultrasound-guided paravertebral block using an intercostal approach.
We describe an ultrasound-guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient's paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient's catheters was infused with 0.2% ropivacaine at 10 mL/h. ⋯ The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5-6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7-5.05). All catheters were removed within 72 h after surgery.