Anesthesia and analgesia
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Anesthesia and analgesia · May 2009
Multicenter StudyPediatric laryngeal dimensions: an age-based analysis.
In children, the cricoid is considered the narrowest portion of the "funnel-shaped" airway. Growth and development lead to a transition to the more cylindrical adult airway. A number of airway decisions in pediatric airway practice are based on this transition from the pediatric to the adult airway. Our primary aim in this study was to measure airway dimensions in children of various ages. The measures of the glottis and cricoid regions were used to determine whether a transition from the funnel-shaped pediatric airway to the cylindrical adult airway could be identified based on images obtained from video bronchoscopy. ⋯ In this study of infants and children, the glottis rather than cricoid was the narrowest portion of the pediatric airway. Similar to adults, the pediatric airway is more cylindrical than funnel shaped based on these video bronchoscopic images. Further studies are needed to determine whether these static airway measurements in anesthetized and paralyzed children reflect the dynamic characteristics of the glottis and cricoid in children.
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Anesthesia and analgesia · May 2009
Improving alarm performance in the medical intensive care unit using delays and clinical context.
In an intensive care unit, alarms are used to call attention to a patient, to alert a change in the patient's physiology, or to warn of a failure in a medical device; however, up to 94% of the alarms are false. Our purpose in this study was to identify a means of reducing the number of false alarms. ⋯ Introducing a 19-s alarm delay and automatically detecting suctioning, repositioning, oral care, and washing could reduce the number of ineffective and ignored alarms from 934 to 274. More reliable alarms could elicit more timely response, reduce workload, reduce noise pollution, and potentially improve patient safety.
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Anesthesia and analgesia · May 2009
Practice GuidelineConsensus statement: First International Workshop on Anesthetics and Alzheimer's disease.
In order to review the current status of the potential relationship between anesthesia and Alzheimer's disease, a group of scientists recently met in Philadelphia for a full day of presentations and discussions. This special article represents a consensus view on the possible link between Alzheimer's disease and anesthesia and the steps required to test this more definitively.
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Anesthesia and analgesia · May 2009
Coordination patterns related to high clinical performance in a simulated anesthetic crisis.
Teamwork is an integral component in the delivery of safe patient care. Several studies highlight the importance of effective teamwork and the need for teams to respond dynamically to changing task requirements, for example, during crisis situations. In this study, we address one of the many facets of "effective teamwork" in medical teams by investigating coordination patterns related to high performance in the management of a simulated malignant hyperthermia (MH) scenario. We hypothesized that (a) anesthesia crews dynamically adapt their work and coordination patterns to the occurrence of a simulated MH crisis and that (b) crews with higher clinical performance scores (based on a time-based scoring system for critical MH treatment steps) exhibit different coordination patterns. ⋯ Our results of the relationship of coordination patterns and clinical performance will inform future research on adaptive coordination in medical teams and support the development of specific training to improve team coordination and performance.
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Anesthesia and analgesia · May 2009
Levels of consciousness during regional anesthesia and monitored anesthesia care: patient expectations and experiences.
Complaints of "intraoperative awareness" after regional anesthesia and monitored anesthesia care have been reported. We hypothesized that this may be due to either unmet expectations regarding levels of consciousness or states of consciousness resembling general anesthesia. ⋯ Furthermore, only 58% of patients had expectations set by the anesthesia provider. These data indicate that, from the patient's perspective, the boundary between general and nongeneral anesthesia is obscured.