Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2010
Randomized Controlled TrialThe accuracy of the anesthetic conserving device (AnaConDa©) as an alternative to the classical vaporizer in anesthesia.
The Anesthetic Conserving Device--AnaConDa® (ACD)--has been compared with a conventional vaporizer. However, the accuracy of the administered concentration of volatile anesthetics was not examined. In the present study we measured the accuracy of the ACD when used as a portable vaporizer. ⋯ We found that the ACD may be a valid alternative to the conventional vaporizer. The ACD is very simple to use, delivery rate needs to be adjusted only once per hour, and the anesthetic savings are independent of the circuit characteristics and fresh gas flow rate.
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Anesthesia and analgesia · Nov 2010
ReviewGenetics for the pediatric anesthesiologist: a primer on congenital malformations, pharmacogenetics, and proteomics.
Molecular genetics is the study, at the molecular level, of how genetic information is stored, inherited, and expressed and of how it influences the structure and function of cells in health and in disease. Although molecular approaches have been used for decades in the laboratory and are at the core of modern medical education, they are only now beginning to influence clinical practice. A variety of sophisticated techniques permit rapid and affordable DNA sequencing, gene expression profiling, gene cloning, gene manipulation, gene transfer, recombinant protein production, and other technologies of enormous biomedical importance. ⋯ With the use of molecular criteria and the diminishing cost of analytic technologies, anesthetic practice will become more individualized, and greater emphasis will be placed on the patient's genetic makeup. Both surgical and nonsurgical decisions will increasingly accommodate molecular data crucial to perioperative anesthetic management. In this article we have summarized three lectures on congenital malformations, pharmacogenetics, and proteomics presented at the 22nd Annual Meeting of the Society for Pediatric Anesthesia.
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Anesthesia and analgesia · Nov 2010
ReviewA critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output.
Numerous cardiac output (CO) monitors have been produced that provide continuous rather than intermittent readings. Bland and Altman has become the standard method for validating their performance against older standards. However, the Bland and Altman method only assesses precision and does not assess how well a device detects serial changes in CO (trending ability). ⋯ A new method of presenting trend data (ΔCO) on a polar plot is proposed. Agreement was shown by the angle with the horizontal axis and ΔCO by the distance from the center. Trending can be assessed by the vertical limits of the data, similar to the Bland and Altman method.
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Anesthesia and analgesia · Nov 2010
Perioperative mortality in patients with pulmonary hypertension undergoing major joint replacement.
There is a paucity of perioperative outcomes data for patients with chronic pulmonary hypertension (PHTN) undergoing noncardiac surgery. Clinicians, therefore, have little information on which to evaluate the risk for morbidity and mortality in this patient population. In this study, we evaluated the incidence and risks of perioperative morbidity and mortality in patients with PHTN undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). ⋯ This analysis demonstrates that patients with PHTN are at increased risk for perioperative mortality after THA and TKA.
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Anesthesia and analgesia · Nov 2010
Case ReportsEpidural hematoma after neuraxial blockade: a retrospective report from China.
We conducted a detailed 54-year retrospective review of patients who developed epidural hematoma after neuraxial blockade in a university hospital and throughout Mainland China. Incidence, risk factors, and outcomes in the Chinese population were identified. ⋯ Patients who had a bacterial infection and required emergency surgery were at increased risk of developing epidural hematoma. There is a significant correlation between good neurologic recovery and short interval to decompressive surgery.