Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
Real-time assessment of perioperative behaviors and prediction of perioperative outcomes.
New onset maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, attention-seeking, and fear of being alone are common in children after outpatient surgery. Preoperative anxiety, fear and distress behaviors of children predict postoperative maladaptive behaviors as well as emergence delirium. Parental anxiety has also been found to influence children's preoperative anxiety. Currently, there is no real-time and feasible tool to effectively measure perioperative behaviors of children and parents. We developed a simple and real-time scale, the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to assess perioperative child and parent behaviors that might predict postoperative problematic behavior and emergence excitement. ⋯ The PACBIS is the first real-time scoring instrument that evaluates children's and parents' perioperative behavior. The specific behaviors identified by the PACBIS might provide targets for interventions to improve perioperative experiences and postoperative outcomes.
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Anesthesia and analgesia · Mar 2009
Case ReportsTreatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer.
Calcium channel blocker (CCB) overdose is often lethal. Conventional medical treatment includes i.v. calcium, high doses of catecholamines, insulin, and glucagon. A new inotropic drug, levosimendan, should be considered in severe CCB poisoning. ⋯ We describe two patients with serious CCB overdose. Despite intensive medical and mechanical cardiovascular support, both patients remained in shock. Hemodynamics gradually improved after administration of levosimendan.
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Anesthesia and analgesia · Mar 2009
Detection of protamine and heparin after termination of cardiopulmonary bypass by thrombelastometry (ROTEM): results of a pilot study.
Our goal of this study was to determine whether protamine's effects on coagulation can be detected and differentiated from those of heparin when using thrombelastometry (ROTEM). ⋯ Our preliminary data show that at termination of CPB administration of additional protamine results in a brief prolongation of coagulation times on the INTEM and HEPTEM test and that ROTEM might be useful in excluding residual heparin in cases showing prolonged ACT.
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Anesthesia and analgesia · Mar 2009
The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia.
The binding of fibrinogen and fibrin to platelets is important in normal hemostasis. The extent of platelet-fibrin interaction can be measured as the viscoelastic strength of clot by rotational thromboelastometry (ROTEM). In this study, we investigated the effect of fibrinogen concentration and its relative contribution to overall clot strength using ROTEM. ⋯ These in vitro and clinical data indicate that the clot strength increases in a fibrinogen concentration-dependent manner independent of platelet count, when analyzed by ROTEM. The maintenance of fibrinogen concentration is critical in the presence of thrombocytopenia. EXTEM (extrinsic activation) and FIBTEM may be useful in guiding fibrinogen repletion therapy.
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Anesthesia and analgesia · Mar 2009
Automatic updating of times remaining in surgical cases using bayesian analysis of historical case duration data and "instant messaging" updates from anesthesia providers.
Operating room (OR) whiteboards (status displays) communicate times remaining for ongoing cases to perioperative stakeholders (e.g., postanesthesia care unit, anesthesiologists, holding area, and control desks). Usually, scheduled end times are shown for each OR. However, these displays are inaccurate for predicting the time that remains in a case. Once a case scheduled for 2 h has been on-going for 1.5 h, the median time remaining is not 0.5 h but longer, and the amount longer differs among procedures. ⋯ For cases taking nearly as long as or longer than scheduled, each 1 min progression of OR time reduces the median time remaining in a case by <1 min. We implemented automated calculation of times remaining for every case at a 29 OR hospital.