Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2009
Comparative StudyIntralipid infusion diminishes return of spontaneous circulation after hypoxic cardiac arrest in rabbits.
Infusion of lipid emulsion has been shown to reverse lipophilic drug-induced cardiovascular collapse in laboratory models and humans. The effect of high dose lipid in nondrug-induced cardiac arrest is, however, uncertain. In a rabbit model of asphyxial pulseless electrical activity (PEA) we compared lipid augmented with standard advanced cardiac life support (ACLS) resuscitation. ⋯ In this model of hypoxia-induced PEA, standard ACLS resulted in greater coronary perfusion pressure and increased ROSC compared with ACLS plus lipid infusion. Lipid emulsion may be contraindicated in cardiac arrest complicated by significant hypoxia.
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Anesthesia and analgesia · Apr 2009
Typical savings from each minute reduction in tardy first case of the day starts.
Analysts and clinicians sitting in operating room (OR) committee meetings cannot evaluate rapidly whether a suggested idea to reduce delays in first case of the day starts can be beneficial economically. ⋯ Typical savings for reducing tardiness of first case of the day starts at a surgical suite equal the product of four values: i) 1.1 min reduction in staffed OR time per 1 min reduction in tardiness, ii) estimate for reductions in tardiness (min) per OR, iii) number of ORs at the suite with more than 8 h of cases, and iv) sum of the average compensations per regularly scheduled minute for personnel in each OR. If small, the analyst and/or clinician can promptly speak up and refocus group conversation toward other potential interventions. If large, the full return on investment analysis would be performed.
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Anesthesia and analgesia · Apr 2009
Tracheal tube exchange: feasibility of continuous glottic viewing with advanced laryngoscopy assistance.
Trachea tube exchange via an airway exchange catheter is commonly combined with conventional laryngoscopy to assist intubation of the trachea. Glottic visualization may not be possible in the difficult airway. A delay in reintubation, airway injury, or intubation failure may complicate "blind" tracheal intubation because of excessive endotracheal tube size or tip impingement on airway structures. Advanced laryngoscopic techniques offering "around the corner" visualization may overcome many of the limitations of conventional laryngoscopy's "line of sight." In this data review, I examined the feasibility and usefulness of transforming a high-risk exchange from a blind procedure into one with improved glottic visualization.