Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 2009
Mortality within 2 years after surgery in relation to low intraoperative bispectral index values and preexisting malignant disease.
A correlation between deep anesthesia (defined as time with Bispectral Index (BIS) <45; T(BIS <45)) and death within 1 yr after surgery has previously been reported. In order to confirm or refute these findings, we evaluated T(BIS <45) as an independent risk factor for death within 1 and 2 yr after surgery and also the impact of malignancy, the predominant cause of death in the previous report. ⋯ Using a similar set of co-variates as in previous work, we confirmed the statistical relation between 1-yr mortality and T(BIS <45), and we extended this observation to 2-yr mortality. However, this relation is sensitive to the selection of co-variates in the statistical model, and a randomized study is required to demonstrate that there really is a causal impact from and T(BIS <45) on postoperative mortality and, if it does, the effect is probably very weak in comparison with co-morbidity as assessed by ASA physical score, the preexisting malignancy status at surgery and age.
-
Anesthesia and analgesia · Feb 2009
Case scheduling preferences of one Surgeon's cataract surgery patients.
The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility. ⋯ The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.
-
Anesthesia and analgesia · Feb 2009
The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients.
Respiratory variations in arterial pulse pressure (DeltaPP) are accurate predictors of fluid responsiveness in mechanically ventilated patients. The aim of our study was to assess the ability of a novel algorithm for automatic estimation of stroke volume variation (SVV) to predict fluid responsiveness in mechanically ventilated patients. ⋯ SVV predicts fluid responsiveness with an acceptable sensitivity and specificity and is also a potential surrogate for continuous monitoring of DeltaPP.
-
Anesthesia and analgesia · Feb 2009
Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio.
We evaluated the usefulness of the hyomental distance (HMD) ratio (HMDR), defined as the ratio of the HMD at the extreme of head extension to that in the neutral position, in predicting difficult visualization of the larynx (DVL) in apparently normal patients, by examining the following preoperative airway predictors, alone and in combination: the modified Mallampati test, HMD in the neutral position, HMD and thyromental distance at the extreme of head extension and HMDR. ⋯ The HMDR with a test threshold of 1.2 is a clinically reliable predictor of DVL.
-
Anesthesia and analgesia · Feb 2009
Intracranial pressure monitoring during percutaneous tracheostomy "percutwist" in critically ill neurosurgery patients.
Tracheostomy is commonly required as part of the management of patients with severe brain damage. Percutaneous dilation tracheostomy is increasingly used in intensive care unit as an alternative to standard surgical tracheostomy. However, this procedure carries the risk of neurological complications, particularly in patients with intracranial hypertension. In this study, we sought to quantify the effects of Percutwist(R) tracheostomy (Rusch-Teleflex Medical) on intracranial pressure (ICP), cerebral perfusion pressure (CPP), arterial CO(2) tension (Paco(2)), and arterial O(2) tension (Pao(2)), in 65 consecutive critically ill patients admitted to the neurosurgical intensive care unit, undergoing bedside percutaneous tracheostomy. ⋯ Percutwist tracheostomy is a single-step method which allows for effective ventilation during the procedure, thus reducing the risk of hypercarbia and development of intracranial hypertension. The technique did not cause secondary pathophysiological insult and could be considered safe in a selected population of brain-injured patients.