Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2010
Comparative StudyHigh-resolution solid-state manometry of the upper and lower esophageal sphincters during anesthesia induction: a comparison between obese and non-obese patients.
The prevalence of obesity has increased dramatically in recent decades. The gastrointestinal changes associated with obesity have clinical significance for the anesthesiologist in the perioperative period. The lower esophageal sphincter and the upper esophageal sphincter play a central role in preventing regurgitation and aspiration. The effects of increased intra-abdominal pressure during anesthesia on the lower esophageal sphincter and the upper esophageal sphincter in obese patients are unknown. In the present study we evaluated, with high-resolution solid-state manometry, the upper esophageal sphincter, lower esophageal sphincter, and barrier pressure (BrP) (lower esophageal pressure--gastric pressure) in obese patients during anesthesia induction and compared them with pressures in non-obese patients. ⋯ Lower esophageal sphincter and BrPs decreased in both obese and non-obese patients during anesthesia induction, but were significantly lower in obese patients. Although the BrP was significantly lower, it remained positive in all patients.
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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.