Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2009
Overweight/obesity and gastric fluid characteristics in pediatric day surgery: implications for fasting guidelines and pulmonary aspiration risk.
The safety of 2-h preoperative clear liquid fasts has not been established for overweight/obese pediatric day surgical patients. Healthy children and obese adults who fasted 2 h have small residual gastric fluid volumes (GFVs), which are thought to reflect low pulmonary aspiration risk. We sought to measure the prevalence of overweight/obesity in our day surgery population. We hypothesized that neither body mass index (BMI) percentile nor fasting duration would significantly affect GFV or gastric fluid pH. In children who were allowed clear liquids up until 2 h before surgery, we hypothesized that overweight/obese subjects would not have increased GFV over lean/normal subjects and that emesis/pulmonary aspiration events would be rare. ⋯ Twenty-seven percent of pediatric day surgery patients are overweight/obese. These children may be allowed clear liquids 2 h before surgery as GFV(IBW) averages 1 mL/kg regardless of BMI and fasting interval. Rare emetic episodes were not associated with shortened fasting intervals in this population.
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Anesthesia and analgesia · Sep 2009
Seventh and eighth year follow-up on workforce and finances of the United States anesthesiology training programs: 2007 and 2008.
We sent follow-up financial and workforce surveys to 121 United States anesthesiology training programs in 2007 and 2008. Seventy-four respondents (61%) demonstrated a continued increase in the institutional support for faculty and stabilization in the number of open positions. Institutional support per faculty full time equivalent with certified nurse anesthetist support removed averages $109,000. A 7% open faculty position rate is characterized by a preponderance of generalists (31%) and pediatric (21%) anesthesiologists.
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Anesthesia and analgesia · Sep 2009
Low tidal volume ventilation in a porcine model of acute lung injury improves cerebral tissue oxygenation.
In study, we investigated the effects of different tidal volumes on cerebral tissue oxygenation and cerebral metabolism in a porcine model of acute lung injury (ALI). We hypothesized that mechanical ventilation with low tidal (LT) volumes improves cerebral tissue oxygenation and metabolism after experimentally induced ALI. ⋯ Protective ventilation with LT yielded a significant improvement in cerebral tissue oxygenation and metabolism compared to HT ventilation in a porcine model of ALI. There was dissociation between arterial and cerebral tissue oxygenation. Cerebral oxygenation and metabolism might have possibly been impaired by a more distinctive inflammatory response in the HT group.
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Anesthesia and analgesia · Sep 2009
Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow.
Spontaneous breathing (SB) activity may improve gas exchange during mechanical ventilation mainly by the recruitment of previously collapsed regions. Pressure support ventilation (PSV) and biphasic positive airway pressure (BIPAP) are frequently used modes of SB, but little is known about the mechanisms of improvement of lung function during these modes of assisted mechanical ventilation. We evaluated the mechanisms behind the improvement of gas exchange with PSV and BIPAP. ⋯ In this model of ALI, the improvements of oxygenation and venous admixture obtained during assisted mechanical ventilation with PSV and BIPAP + SB were explained by the redistribution of PBF toward nondependent lung regions rather than recruitment of dependent zones.
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Anesthesia and analgesia · Sep 2009
Randomized Controlled TrialNasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study.
It is often difficult to correctly place nasogastric (NG) tubes under anesthesia. We hypothesized that simple modifications in technique of NG tube insertion will improve the success rate. ⋯ The success rate of NG tube insertion can be increased by using a ureteral guidewire as stylet, a slit endotracheal tube as an introducer, or head flexion with lateral neck pressure. Head flexion with lateral neck pressure is the easiest technique that has a high success rate and fewest complications.