Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
Review Meta AnalysisDoes thromboelastography predict postoperative thromboembolic events? A systematic review of the literature.
Since thromboelastography (TEG) can detect hypercoagulable states, it is a potentially useful test for predicting postoperative thromboembolic complications. Therefore, we performed a systematic review of the literature to evaluate the accuracy of TEG in predicting postoperative thromboembolic events. ⋯ The predictive accuracy of TEG for postoperative thromboembolic events is highly variable. To determine if the TEG is a clinically useful screening test in high-risk surgical populations, more prospective studies are needed.
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Anesthesia and analgesia · Mar 2009
Multicenter StudyThe incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium.
We used a large database of prospectively collected data on pediatric sedation/anesthesia outside the operating room provided by a wide range of pediatric specialists to delineate the nature and frequency of adverse events associated with propofol-based sedation/anesthesia care. ⋯ We report the largest series of pediatric propofol sedation/anesthesia for procedures outside the operating room. The data indicate that propofol sedation/anesthesia is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation/anesthesia services. However, the safety of this practice is dependent on a system's ability to manage less serious events. We propose that our data suggest variables for training and credentialing providers of propofol sedation/anesthesia and the system characteristics that promote safe use of this drug.
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Anesthesia and analgesia · Mar 2009
ReviewThe teaching of professionalism during residency: why it is failing and a suggestion to improve its success.
Professionalism is one of the core competencies to be taught and evaluated during residency. A review of the literature suggests that professionalism is not completely understood or practiced. The teaching of professionalism has been incorporated into the educational programs for residents. ⋯ Due to the hidden curriculum, a possible means of improving professionalism involves the development of a program for faculty. This program must include not only topics but time for personal reflection of one's knowledge and actions. Self-reflection allows for the development of a true understanding and practice of professionalism and may improve professional behavior.
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Anesthesia and analgesia · Mar 2009
Randomized Controlled Trial Comparative StudyManual versus target-controlled infusion remifentanil administration in spontaneously breathing patients.
The combination of propofol-remifentanil for procedural deep sedation in spontaneously breathing patients is characterized by the frequent incidence of side effects, especially respiratory depression. These side effects may be due to either the drug combination or the drug delivery technique. Target-controlled infusion (TCI) might optimize drug delivery. In this prospective, randomized, double-blind study in patients undergoing elective colonoscopy, we thus tried to answer two questions: first, if adding remifentanil to propofol surpasses the disadvantages of the combination of these two products, and second, if administration of remifentanil via TCI decreases the incidence of side effects, compared to manually controlled administration. ⋯ The combination of remifentanil and propofol for deep sedation in spontaneously breathing patients, offered better conditions for colonoscopy than propofol used as a single drug. Remifentanil administered via TCI resulted in a decrease in propofol dosing and in a lower incidence in apnea and respiratory depression (TCI n = 7, MCI n = 16, P < 0.05), compared to manually controlled administration of remifentanil.