Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2010
Review Practice GuidelineSociety for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery.
Optimal evidence-based perioperative blood glucose control in patients undergoing ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing ambulatory surgery. A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. ⋯ It was revealed that there is insufficient evidence to provide strong recommendations for the posed clinical questions. In the absence of high-quality evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. In addition, areas of further research were also identified.
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Anesthesia and analgesia · Dec 2010
ReviewA program for computing the prediction probability and the related receiver operating characteristic graph.
Prediction probability (P(K)) and the area under the receiver operating characteristic curve (AUC) are statistical measures to assess the performance of anesthetic depth indicators, to more precisely quantify the correlation between observed anesthetic depth and corresponding values of a monitor or indicator. In contrast to many other statistical tests, they offer several advantages. First, P(K) and AUC are independent from scale units and assumptions on underlying distributions. ⋯ In clinical investigations, both measures are applied for indicator assessment, where ambiguous usage and interpretation may be a consequence. Therefore, a summary of the concepts of P(K) and AUC including brief and easily understandable proof of their equality is presented in the text. The exposure introduces readers to the algorithms of the provided computer program and is intended to make standardized performance tests of depth of anesthesia indicators available to medical researchers.
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Anesthesia and analgesia · Dec 2010
ReviewContinuous spinal anesthesia and analgesia in obstetrics.
The development of the technique of continuous spinal anesthesia as it relates to the obstetric population is recounted. The advantages and disadvantages of continuous spinal anesthesia are examined, currently available catheters and kits are reviewed, and strategies for the management of continuous spinal techniques for labor analgesia and surgical anesthesia are discussed. Continuous spinal anesthesia may have particular value over other regional techniques in several specific clinical circumstances.
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Women in labor who receive epidural analgesia are more likely to experience hyperthermia and overt clinical fever. The gradual development of modest hyperthermia observed in laboring women with epidural analgesia is not seen in those electing other forms of analgesia or unmedicated labor. Clinical fever is also far more likely in women laboring with epidural analgesia. ⋯ More ominously, maternal inflammatory fever is associated with neonatal brain injury, manifest as cerebral palsy, encephalopathy, and learning deficits in later childhood. At present, there are no safe and effective means to inhibit epidural-associated fever. Future research should define the etiology of this fever and search for safe and effective interventions to prevent it and to inhibit its potential adverse effects on the neonatal brain.
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Anesthesia and analgesia · Dec 2010
ReviewWhat's new in obstetric anesthesia in 2009? An update on maternal patient safety.
Every year, the Society of Obstetric Anesthesia and Perinatology nominates 1 individual to survey the prior year's literature and to identify the most notable articles for the science and practice of obstetric anesthesiology. This article reviews the 2009 literature, focusing on the theme of maternal patient safety, and advancing the notion of the obstetric anesthesiologist as both a perioperative and a peripartum physician. Three specific topics are reviewed: complications of obstetric anesthesia, general obstetric complications, and quality and safety in peripartum care.