Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2009
Case ReportsManagement of the difficult infant airway with the Storz Video Laryngoscope: a case series.
The incorporation of video technology into laryngoscopes provides an additional option for the management of difficult intubations. We report the successful use of the Miller 1 Storz Video Laryngoscope in seven infants with difficult direct laryngoscopy.
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Anesthesia and analgesia · Sep 2009
ReviewIntraoperative awareness during general anesthesia for cesarean delivery.
Intraoperative awareness is defined as the spontaneous recall of an event occurring during general anesthesia. A move away from rigid anesthetic protocols, which were designed to limit drug transmission across the placenta, has reduced the incidence of awareness during cesarean delivery to approximately 0.26%. Nevertheless, it remains an undesirable complication with potential for the development of posttraumatic stress disorder. ⋯ Because of its rapid uptake, nitrous oxide remains an important adjunct to reduce the risk of awareness during emergency cesarean delivery. In the absence of fetal compromise, there is no rationale for an inspired oxygen concentration above 0.33. Deeper levels of anesthesia reduce the incidence of awareness; current evidence does not suggest an increased risk of tocolysis or fetal morbidity.
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Anesthesia and analgesia · Sep 2009
Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs.
Anesthesiologists have a higher rate of substance use disorders than other physicians, and their prognoses and advisability to return to anesthesiology practice after treatment remain controversial. Over the past 25 yr, physician health programs (PHPs), created under authority of state medical regulatory boards, have become primary resources for management and monitoring of physicians with substance abuse and other mental health disorders. ⋯ Anesthesiologists in our sample treated and monitored for substance disorders under supervision of PHPs had excellent outcomes similar to other physicians, with no higher mortality, relapse rate, or disciplinary rate and no evidence in their records of patient harm. It is postulated that differences of study design account for contradictory conclusions from other reports.
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Anesthesia and analgesia · Sep 2009
The perioperative validity of the visual analog anxiety scale in children: a discriminant and useful instrument in routine clinical practice to optimize postoperative pain management.
Because children's anxiety influences pain perception, perioperative anxiety should be evaluated in clinical practice with a unique, useful, and valid tool to optimize pain management. In this study, we evaluated psychometric properties of the visual analog scale (VAS)-anxiety for children and to study its perioperative relevance in clinical practice. ⋯ VAS-anxiety is a useful and valid tool to assess perioperative anxiety in children aged 7-16 yr. The influence of children's and parents' anxiety on children's postoperative pain suggests that VAS-anxiety should be recommended routinely for postoperative clinical practice to optimize anxiety and pain management.
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Anesthesia and analgesia · Sep 2009
The practice of and documentation on withholding and withdrawing life support: a retrospective study in two Dutch intensive care units.
We determined how often life support was withheld or withdrawn in patients who died in the intensive care unit (ICU) or early after ICU discharge and evaluated documentation on decisions regarding these changes in life support orders. ⋯ ICU nonsurvivors and patients who die shortly after ICU discharge predominantly die with orders to withhold or withdraw life support. Documentation on the decisions to forgo full life support is poor.