Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2010
Temporally and regionally disparate differences in plasmin activity by tranexamic acid.
A major complication associated with cardiac surgery is excessive and prolonged bleeding in the perioperative period. Improving coagulation by inhibiting fibrinolysis, primarily through inhibition of plasmin activity (PLact) with antifibrinolytics such as tranexamic acid (TXA), has been a pharmacological mainstay in cardiac surgical patients. Despite its almost ubiquitous use, the temporal and regional modulation of PLact profiles by TXA remains unexplored. Accordingly, we developed a fluorogenic-microdialysis system to measure in vivo dynamic changes in PLact after TXA administration in a large animal model. ⋯ Using a large animal model and in vivo microdialysis measurements of PLact, the unique findings from this study were 2-fold. First, TXA induced temporally distinct PLact profiles within the plasma and selected interstitial compartments. Second, TXA caused region-specific changes in PLact profiles. These temporal and regional differences in the effects of TXA may have important therapeutic considerations when managing fibrinolysis in the perioperative period.
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Anesthesia and analgesia · Mar 2010
Scientific publications in anesthesiology journals from mainland China, Taiwan, and Hong Kong: a 10-year survey of the literature.
The past 20 yr have seen significant growth in China's role in the international community. This same growth and international presence is occurring in the field of anesthesiology. The research status in anesthesiology among Chinese individuals in the 3 major regions of China--mainland China, Hong Kong, and Taiwan--is unknown. We analyzed articles published in peer-reviewed international anesthesiology journals cited by both PubMed and Science Citation Index from these 3 regions. ⋯ The total number of articles from China published in highly cited anesthesiology journals increased markedly from 1999 to 2008, with articles from mainland China increasing substantially after 2004, whereas the number of publications from Hong Kong decreased. The average impact factor was similar for all 3 regions, ranging from 2.2 to 2.8. Anesthesia & Analgesia published more articles from Chinese authors from all 3 regions than any other journal.
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Anesthesia and analgesia · Mar 2010
Sensory testing of distal sural and posterior tibial nerves provides early prediction of surgical anesthesia after single-injection infragluteal-parabiceps sciatic nerve block.
Surgical anesthesia for reconstructive ankle surgery requires sensory and motor block of all the terminal nerve distributions of the sciatic nerve. In this prospective observational study, we investigated the value of sensory and motor testing of the foot, after local anesthetic injection, for predicting complete sciatic nerve blockade and the duration of testing required for identifying incomplete anesthesia. ⋯ Sural anesthesia assessed at the lateral heel and the lateral aspect of the foot and the fifth toe identified within 4 to 6 minutes demonstrated a similar posttest predictive value as anesthesia in the distributions of the posterior tibial and peroneal nerves or motor movement of the foot at later intervals. In addition, failure to achieve sural anesthesia within 10 minutes was predictive of block failure.
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Anesthesia and analgesia · Mar 2010
A novel classification instrument for intraoperative awareness events.
Intraoperative awareness with explicit recall occurs in approximately 1-2 cases per 1000. Given the rarity of the event, a better understanding of awareness and its sequelae will likely require the compilation of data from numerous studies. As such, a standard description and expression of awareness events would be of value. ⋯ We report a novel classification instrument for intraoperative awareness events that has excellent inter-observer agreement and that may facilitate the study of intraoperative awareness.
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Anesthesia and analgesia · Mar 2010
Development of a staff recall system for mass casualty incidents using cell phone text messaging.
After a mass casualty incident (MCI), rapid mobilization of hospital personnel is required because of an expected surge of victims. Risk assessment of our department's manual phone tree recall system revealed multiple weaknesses that would limit an effective response. Because cell phone use is widespread within the department, we developed and tested a staff recall system, based in our anesthesia information management system (AIMS), using Short Message Service (SMS) text messaging. ⋯ Our SMS staff recall system is likely to be able to rapidly mobilize sufficient numbers of anesthesia personnel in response to an MCI, but actual performance cannot be predicted with confidence. Using our AIMS as the source for contact information and from which to send messages was simple, inexpensive, and easy to implement. Updating contact information, periodic testing, and analysis of responses to simulated disaster alerts are essential for the effective functioning of such a system. However, maintenance of alternative methods of communication is recommended, because there may be more significant message transmission delays and failures during an actual MCI, and not all staff will receive the text message in a timely fashion.