Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2010
A survey of current management of neuromuscular block in the United States and Europe.
Most anaesthetists and anesthesiologists incorrectly estimate the incidence of post-operative residual paralysis to be less than 1%.
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Anesthesia and analgesia · Jul 2010
Global warming potential of inhaled anesthetics: application to clinical use.
Inhaled anesthetics are recognized greenhouse gases. Calculating their relative impact during common clinical usage will allow comparison to each other and to carbon dioxide emissions in general. ⋯ Under comparable and common clinical conditions, desflurane has a greater potential impact on global warming than either isoflurane or sevoflurane. N2O alone produces a sizable greenhouse gas contribution relative to sevoflurane or isoflurane. Additionally, 60% N2O combined with potent inhaled anesthetics to deliver 1 MAC of anesthetic substantially increases the environmental impact of sevoflurane and isoflurane, and decreases that of desflurane. N2O is destructive to the ozone layer as well as possessing GWP; it continues to have impact over a longer timeframe, and may not be an environmentally sound tradeoff for desflurane. From our calculations, avoiding N2O and unnecessarily high fresh gas flow rates can reduce the environmental impact of inhaled anesthetics.
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Anesthesia and analgesia · Jul 2010
Control chart monitoring of the numbers of cases waiting when anesthesiologists do not bring in members of call team.
An anesthesia group staffing agreement with a hospital often specifies the minimum number of operating rooms (ORs) to be covered during evening or weekend hours. Frequently, 1 anesthesiologist works in-house and others take call from home, coming in if multiple cases are waiting to be done. The anesthesiologist in-house sometimes does not bring in colleagues from home when the number of ORs he can supervise is less than the number specified in the agreement with the hospital (i.e., assignment is less than staffing). Queuing occurs even if managers have selected an appropriate number of ORs to be run during evenings and weekends (i.e., the number of cases [jobs] exceeds the number of ORs [identical machines] that are actually run). ⋯ Anesthesiologists sometimes do not notify call team members when cases are waiting and the number of ORs running is less than allocated. The number of cases waiting, rather than the amount of waiting, is more appropriate for monitoring trends over time. Simple Shewhart charts can be used for monitoring contractually specified staffing.
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Anesthesia and analgesia · Jul 2010
ReviewLumbar cerebrospinal fluid drainage for thoracoabdominal aortic surgery: rationale and practical considerations for management.
Paraplegia remains one of the most devastating complications of thoracoabdominal aortic surgery and is associated with a significant increase in both morbidity and mortality. Modern aortic repair techniques use many modalities aimed at reducing the risk of spinal cord ischemia inherent with surgical management. One of these modalities that acts via optimizing spinal cord blood flow is lumbar cerebrospinal fluid (CSF) drainage. ⋯ Despite no definitive proof of efficacy for reducing spinal cord injury, there are compelling data supporting its use. However, the potential benefit of CSF drainage must be balanced against the risks associated with its use, including nerve injury during insertion, compressive neuraxial hematoma formation, intracranial hemorrhage due to excessive drainage, and infection. The optimal benefit to risk ratio can be achieved by understanding the rationale for its use and following practical management guidelines.