Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2009
Randomized Controlled TrialFacial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth.
Facial nerve (FN) monitoring has been accepted as a standard of care in craniofacial, middle ear, and skull-based surgeries as a means of reducing iatrogenic injury, localizing the FN, and predicting postoperative neurologic function. Past studies have also shown that FN electromyographic monitoring (FNEMG) may have some clinical utility as a monitor of anesthetic depth and predicting patient movement. In this study, we evaluated Bispectral Index (BIS) and FNEMG using two different anesthetic techniques to determine whether these monitors can be used to predict movement in patients undergoing skull-based surgical procedures. ⋯ This study shows that FNEMG may be an effective monitor for predicting patient movement when undergoing craniofacial and skull-based surgeries. BIS monitoring, however, was not an adequate monitor to predict movement in this patient population. The DES group had more hemodynamic variability and FNEMG activity, whereas TIVA proved to be a more effective anesthetic in preventing patient movement when clinically titrated to produce stable operation conditions. FNEMG was a useful clinical tool to help predict and prevent movement in these patients.
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Anesthesia and analgesia · Aug 2009
Evaluating the requirements of electroencephalograph instruction for anesthesiology residents.
During a 1-mo neurosurgical intensive care unit rotation, anesthesiology residents interpret electroencephalograms (EEGs) performed throughout the institution, including intraoperative EEGs. The curriculum goal is to increase familiarity with EEG use and interpretation with 20 EEG interpretations with a clinical neurophysiologist during this rotation. We aimed to determine whether the EEG curriculum goals could be achieved with fewer EEG interpretations. ⋯ This innovative, collaborative approach using the expertise of the clinical neurophysiologist met the curriculum goals after 10 supervised EEG interpretations, as measured by the study assessment tool.
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Anesthesia and analgesia · Aug 2009
Case ReportsAutotriggering during pressure support ventilation due to cardiogenic oscillations.
Newer generation anesthesia machines are equipped with a pressure support mode of ventilation, which can be used to support spontaneous ventilation in anesthetized patients. The Drager Apollo anesthesia machine uses an inspiratory limb hot-wire flow sensor to measure inspiratory flow rates. ⋯ In the case we are presenting, cardiac oscillations produced inspiratory flow rates that exceeded the flow trigger and autotriggered pressure support breaths. Autotriggering could be suppressed by increasing the trigger threshold or the positive end-expiratory pressure setting.
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Anesthesia and analgesia · Aug 2009
Preinsertion paramedian ultrasound guidance for epidural anesthesia.
Ultrasound is receiving growing interest for improving the guidance of needle insertion in epidural anesthesia. Defining a paramedian ultrasound scanning technique would be helpful for correctly identifying the vertebral level. Finding surrogate measures of the depth of the epidural space may also improve the ease of scanning. ⋯ Paramedian ultrasound can be used to estimate the midline depth to the epidural space. The surrogate measures are not sufficiently correlated with the depth to the epidural space to recommend them as a replacement for the actual depth to the epidural space measurement.
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Anesthesia and analgesia · Aug 2009
Prehospital intubations and mortality: a level 1 trauma center perspective.
Ryder Trauma Center is a Level 1 trauma center with approximately 3800 emergency admissions per year. In this study, we sought to determine the incidence of failed prehospital intubations (PHI), its correlation with hospital mortality, and possible risk factors associated with PHI. ⋯ This prospective study showed a 31% incidence of failed PHI in a large metropolitan trauma center. We found no difference in mortality between patients who were properly intubated and those who were not, supporting the use of bag-valve-mask as an adequate method of airway management for critically ill trauma patients in whom intubation cannot be achieved promptly in the prehospital setting.