Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
The effects of neonatal isoflurane exposure in mice on brain cell viability, adult behavior, learning, and memory.
Volatile anesthetics, such as isoflurane, are widely used in infants and neonates. Neurodegeneration and neurocognitive impairment after exposure to isoflurane, midazolam, and nitrous oxide in neonatal rats have raised concerns regarding the safety of pediatric anesthesia. In neonatal mice, prolonged isoflurane exposure triggers hypoglycemia, which could be responsible for the neurocognitive impairment. We examined the effects of neonatal isoflurane exposure and blood glucose on brain cell viability, spontaneous locomotor activity, as well as spatial learning and memory in mice. ⋯ Prolonged isoflurane exposure in neonatal mice led to increased immediate brain cell degeneration, however, no significant reductions in adult neuronal density or deficits in spontaneous locomotion, spatial learning, or memory function were observed.
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Anesthesia and analgesia · Jan 2009
Electrical noise in the intraoperative magnetic resonance imaging setting.
Intraoperative magnetic resonance imaging (iMRI) is a tool now commonly used in neurosurgery. Safe and reliable patient care in this (or any other) operating room setting depends on an environment, where electrical noise (EN) does not interfere with the operation of the electronic monitoring or imaging equipment. In this investigation, we evaluated the EN generated by the iMRI system and the anesthesia patient monitor used at this institution that impacts the performance of these two devices. ⋯ The EN generated by our anesthesia patient monitor is within acceptable limits for the iMRI system. The iMRI generates EN which renders the ECG unreadable in the most commonly used filter mode. The monitor's filters diminish this noise but also alter the morphology of the ECG waveform. The anesthesiologist must be cognizant of these technical compromises and recognize that adjusting the ECG filters on the monitor is required to obtain a useful ECG signal for patient monitoring during the iMRI scan but that the diagnostic value of the ECG will be reduced.
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Anesthesia and analgesia · Jan 2009
Case ReportsMigration of a thoracic epidural catheter into the intercostal space via the intervertebral foramen.
We describe a documented migration of a thoracic epidural catheter into the thoracic cage in a 5-wk-old with DiGeorge's syndrome and an uncorrected acyanotic Tetralogy of Fallot who underwent laparotomy for malrotation, gastric fundoplication, and gastrostomy tube insertion under combined general and epidural anesthesia. A 20-gauge stimulating catheter was inserted caudally and advanced cephalad to the thoracic level while applying a low electrical current (1-10 mA) to confirm epidural placement at approximately T5-6. Despite good pain control through the third postoperative day, using an epidural infusion of bupivacaine 0.1% at 1-1.2 mL/h, radiography demonstrated catheter migration into the seventh intercostal space.
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Anesthesia and analgesia · Jan 2009
Comparative StudySubspecialty impact factors: the contribution of pediatric anesthesia and pain articles.
The Science Citation Index "Journal Impact Factor" (JIF) is widely used to assess journal quality and prestige. The JIFs for the specialty anesthesia are reported annually, however, the impact factors (IFs) for subspecialties in those journals have not been reported. Therefore, we compared the IFs of pediatric anesthesia (Ped IFs) and pain (Pain IFs) articles from four anesthesia journals for two epochs. ⋯ Ped IFs were consistently less than the JIFs in which they were published and the Pain IFs, except for the British Journal of Anaesthesia 2005 in the latter case. The numbers of citations of pediatric anesthesia articles were greater in journals with greater IFs. The implications of subspecialty IFs warrant further consideration.
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Anesthesia and analgesia · Jan 2009
Six-year follow-up on work force and finances of the United States anesthesiology training programs: 2000 to 2006.
In the mid 1990s, interest in the field of anesthesiology decreased significantly among medical students, resulting in a decreasing resident class size and, subsequently, fewer anesthesiologists entering the United States workforce. This apparent practitioner shortage was associated with increased salary demands, which placed anesthesiology training departments in financial jeopardy. Starting in 1999, a survey was sent to the department chairs of the United States anesthesiology training programs to assess the status of faculty and finances of their departments. Follow-up surveys have been conducted each year thereafter. We present the results of the 2006 survey and 7 yr trend data. ⋯ This current survey reveals a continuing need for institutional support to keep anesthesiology training departments financially solvent. The amount of support is associated with the reimbursement for anesthesia work. There is also a continuing, but decreasing, number of open faculty anesthesiologist positions nationwide.