Anesthesia and analgesia
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Surgical morbidity is a significant public health issue worldwide. It is estimated that >230 million surgical procedures are performed each year, with an estimated mortality of at least 0.4% and morbidity of between 3% and 17%. Furthermore, there are potentially far-reaching consequences of a complicated perioperative course, because perioperative morbidity is associated with reduced long-term survival. ⋯ We also review the strengths and limitations of the measures used to assess outcome after surgery, including patient-centered variables such as mortality and morbidity scores, and patient-related outcome measures. Finally, we suggest the direction of future work, which should be aimed at improving the precision of tools for describing perioperative risk, and of the measures used to assess the outcomes and quality of surgical health care. These tools are the building blocks of high-quality clinical trials, epidemiological studies, and quality improvement programs.
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Anesthesia and analgesia · Apr 2011
Randomized Controlled Trial Comparative StudyAirway scope for tracheal intubation in the lateral position.
Tracheal intubation in the lateral position is difficult because the laryngeal view is compromised during direct laryngoscopy. The Airway Scope facilitates intubation even when laryngeal views are poor with direct laryngoscopy, as they often are in the lateral position. We thus compared the efficacy of the Airway Scope in supine patients with those in the left- and right-lateral positions. ⋯ Despite worse laryngoscopic views in either lateral position than when patients were supine, intubation with the Airway Scope offered high success rates. Furthermore, intubation time using the Airway Scope in either lateral position was not longer by >10 seconds than in the supine position. The Airway Scope thus seems to be a useful tool when tracheal intubation is required in a laterally positioned patient.
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Anesthesia and analgesia · Apr 2011
Randomized Controlled Trial Comparative StudyThe effect of manipulation of the programmed intermittent bolus time interval and injection volume on total drug use for labor epidural analgesia: a randomized controlled trial.
Programmed intermittent bolus administration of epidural anesthetic solution compared with continuous infusion results in decreased anesthetic consumption and increased patient satisfaction. In this randomized and blinded study, we evaluated bupivacaine consumption and other analgesic outcomes when the programmed intermittent bolus time interval and volume were manipulated during the maintenance of epidural labor analgesia. ⋯ Extending the programmed intermittent bolus interval and volume from 15 minutes to 60 minutes, and 2.5 mL to 10 mL, respectively, decreased bupivacaine consumption without decreasing patient comfort or satisfaction.
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Anesthesia and analgesia · Apr 2011
Comparative StudyA comparison of three methods of hemoglobin monitoring in patients undergoing spine surgery.
Hemoglobin values (Hb) can facilitate decisions regarding perioperative transfusion management. Currently, Hb can be determined invasively by analyzing blood via laboratory Co-Oximetry (tHb) or by point-of-care HemoCue (HCue). Recently, a new noninvasive, continuous spectrophotometric sensor (Masimo SpHb) was introduced into clinical practice. We compared the accuracy of the SpHb and HCue with tHb. ⋯ Although HCue was consistently accurate, our data confirm that SpHb often correlated well with tHb values. Yet our study indicates that SpHb may not be as accurate as clinically necessary in some patients. Improved refinement of continuous, noninvasive technology, such as SpHb, could address important clinical requirements.
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Anesthesia and analgesia · Apr 2011
Comparative StudyIdentifying and managing technical faults in the anesthesia machine: lessons learned from the Israeli Board of Anesthesiologists.
The potential for catastrophe resulting from anesthetic equipment failure and the failure of training programs to adequately prepare residents to detect and manage equipment failure prompted the Israel Board of Anesthesiologists to include simulation-based testing in the Objective Structured Clinical Evaluation component of the Israeli Board Examination in Anesthesiology. ⋯ During simulation-based board examination most senior anesthesia residents became aware of equipment failures but many failed to correctly diagnosis and manage the failure.