Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2011
Comparative Study2007 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines on perioperative cardiac evaluation are usually incorrectly applied by anesthesiology residents evaluating simulated patients.
The 2007 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the accepted standard for perioperative cardiac evaluation. Anesthesiology training programs are required to teach these algorithms. We estimated the percentage of residents nationwide who correctly applied suggested testing algorithms from the ACC/AHA guidelines when they evaluated simulated patients in common clinical scenarios. ⋯ The results show that fewer than half of anesthesiology residents nationwide correctly demonstrate the approach considered the standard of care for preoperative cardiac evaluation. Further study is necessary to elucidate the correct intervention(s), such as use of decision support tools, increased clarity of guidelines for routine use, adjustment in educational programs, and/or greater familiarity of responsible faculty with the material.
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Anesthesia and analgesia · Apr 2011
Comparative StudyA low approach to interscalene brachial plexus block results in more distal spread of sensory-motor coverage compared to the conventional approach.
A low approach to the interscalene block (LISB) deposits local anesthetic farther caudad on the brachial plexus compared with the conventional interscalene block (ISB). We compared the efficacy of LISB and ISB in achieving anesthesia of the distal extremity in 254 patients having upper extremity surgery. ⋯ There was significantly greater sensory-motor block of regions below the elbow with the LISB compared with ISB (P < 0.001 for both sensory and motor coverage). Our data indicate that LISB results in a higher incidence of distal elicited motor response and greater sensory-motor blockage of the wrist and hand.
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Anesthesia and analgesia · Apr 2011
Comparative StudyParental recall of anesthesia information: informing the practice of informed consent.
Informed consent is a process of sharing information that facilitates the individual patient's right to self-determination. Despite its importance in anesthesia practice, the process of informed consent is rarely audited or examined. As such, there are only limited data with respect to anesthesia consent practices, particularly within the pediatric setting. We designed this study, therefore, to examine the information that parents seek regarding their child's anesthesia, what they are told, who told them, and how much of the information they recall. ⋯ Results showed that disclosure of anesthesia information to parents was often incomplete, and their recall thereof, was poor. The finding that recall of consent information provided by anesthesia providers was better than when provided by surgical personnel may serve to further the debate regarding the appropriate vehicles for anesthesia consent.
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Anesthesia and analgesia · Apr 2011
Comparative StudyEpinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration.
Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine. ⋯ In this swine model of prolonged VF cardiac arrest, epinephrine administration during CPR improved outcomes. In addition, early IO epinephrine improved outcomes in comparison with delayed IV epinephrine.
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Anesthesia and analgesia · Apr 2011
Analysis of interventions influencing or reducing patient waiting while stratifying by surgical procedure.
Facilitation of the coordination of presurgical care is desirable not only from the patients' perspective, but also for increasing operating room productivity of surgeons and anesthesiologists. Times from each patient's first referral to a surgeon until surgery will be available on a vast scale from regional health information exchanges. Treatments (interventions) can include, for example, case management and use of health system networks with common electronic medical records. ⋯ Over the ranges of estimated parameter values, prior Monte-Carlo simulation studies showed that meta-analysis using the simple method of moments was appropriate. However, because many treatment/procedure combinations have small sample sizes, confidence interval coverage for the treatment effect was too narrow other than when the degrees of freedom were corrected. Nevertheless, the resulting statistical methodology is straightforward to apply because the data needed are just the summary statistics and the method involves just a series of equations to be followed in a stepwise manner (e.g., in a spreadsheet program such as Microsoft Office Excel).