Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
Incidence and risk factors for perioperative hyperglycemia in children with traumatic brain injury.
Hyperglycemia after traumatic brain injury (TBI) is associated with poor outcome. In this study, we examined the incidence and risk factors for perioperative hyperglycemia in children with TBI. ⋯ Perioperative hyperglycemia was common and intraoperative hypoglycemia was not rare, but more frequent intraoperative glucose sampling may be needed to better determine the incidence of hypo and hyperglycemia during the perioperative period. Age <4 yr, severe TBI and the presence of multiple lesions, including subdural hematoma, were risk factors for perioperative hyperglycemia.
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Anesthesia and analgesia · Jan 2009
Failure of augmentation of labor epidural analgesia for intrapartum cesarean delivery: a retrospective review.
In this study, we aimed to identify the incidence and predictive factors associated with failed labor epidural augmentation for cesarean delivery. Data of parturients, who had received neuraxial labor analgesia and who subsequently required intrapartum cesarean delivery during an 18-mo period, were retrospectively studied. ⋯ Of the 1025 parturients, 1.7% had failed epidural extension. Predictors of failed epidural anesthesia included initiation of labor analgesia with plain epidural technique (compared to combined spinal-epidural) (P = 0.001), >or=2 episodes of breakthrough pain during labor (P < 0.001) and prolonged duration of neuraxial labor analgesia (P = 0.02).
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Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Comparative StudyPerformance of certified registered nurse anesthetists and anesthesiologists in a simulation-based skills assessment.
Anesthesiologists and certified registered nurse anesthetists (CRNAs) must acquire the skills to recognize and manage a variety of acute intraoperative emergencies. A simulation-based assessment provides a useful and efficient means to evaluate these skills. In this study, we evaluated and compared the performance of board-certified anesthesiologists and CRNAs managing a set of simulated intraoperative emergencies. ⋯ Although anesthesiologists, on average, achieved a modestly higher overall score, there was marked and similar variability in both groups. This wide range suggests that certification in either discipline may not yield uniform acumen in management of simulated intraoperative emergencies. In both groups, there were practitioners who failed to diagnose and treat simulated emergencies. If this is reflective of clinical practice, it represents a patient safety concern. Simulation-based assessment provides a tool to determine the ability of practitioners to respond appropriately to clinical emergencies. If all practitioners could effectively manage these critical events, the standard of patient care and ultimately patient safety could be improved.
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Anesthesia and analgesia · Jan 2009
An evaluation of the epidural catheter position by epidural nerve stimulation in conjunction with continuous epidural analgesia in adult surgical patients.
The epidural stimulation test to confirm epidural catheter position has been described as being simple, fast, and reliable. We evaluated the feasibility of the epidural stimulation test and its potential in contributing to effective postoperative continuous epidural analgesia. ⋯ The epidural stimulation test was often associated with technical difficulties and interpretation problems. The role of the repeated use of the epidural stimulation test for quality assurance in patients undergoing postoperative continuous epidural analgesia remains undetermined.