Anesthesia and analgesia
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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.
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Workload has increased greatly over the past decade for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging. ⋯ Future workload for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging will depend on trends in the total number of scans performed. Workload may also be sensitive to factors that increase scan duration or alter the percentage of patients in the 3-5 yr age group. It may additionally depend on reimbursements from insurance companies.
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Anesthesia and analgesia · May 2009
The effect of inguinal compression, Valsalva maneuver, and reverse Trendelenburg position on the cross-sectional area of the femoral vein in children.
For facilitation of femoral venous cannulation, the larger cross-sectional area (CSA) of the vein is helpful and can be achieved by inguinal compression, Valsalva maneuver, or the reverse Trendelenburg position. In this study, we evaluated these methods using ultrasonography in children. ⋯ Inguinal compression effectively increases the CSA of the femoral vein and its effect is also prominent in the Trendelenburg position. Valsalva maneuver is more effective in small children. Gravitational position changes have little effect on the size of the femoral vein in children.