Anesthesia and analgesia
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Anesthesia and analgesia · May 2011
Evaluation of a mandatory quality assurance data capture in anesthesia: a secure electronic system to capture quality assurance information linked to an automated anesthesia record.
Efforts to assure high-quality, safe, clinical care depend upon capturing information about near-miss and adverse outcome events. Inconsistent or unreliable information capture, especially for infrequent events, compromises attempts to analyze events in quantitative terms, understand their implications, and assess corrective efforts. To enhance reporting, we developed a secure, electronic, mandatory system for reporting quality assurance data linked to our electronic anesthesia record. ⋯ We demonstrate the implementation in an academic anesthesia department of a secure clinical event reporting system linked to an AIMS. The system enforces entry of quality assurance information (either no clinical event or notification of a clinical event). System implementation resulted in capturing nearly twice the number of events at a relatively steady case load.
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Patients with congenital long QT syndrome (LQTS) are susceptible to an episodic malignant ventricular tachyarrhythmia known as torsade de pointes, which can result in a cardiac arrest and death. Patients can suffer severe cardiac events resulting in syncope, seizures, and sudden cardiac death during times of physical and emotional stress and when exposed to certain drugs including anesthetics. We describe the occurrence of perioperative adverse events (AEs) related to arrhythmias in children with congenital LQTS exposed to volatile general anesthesia and describe associated risk factors. ⋯ There is an increased risk of AEs during periods of enhanced sympathetic activity, especially emergence. This risk seems to be further enhanced if drugs are administered at this time that are known either to prolong the corrected QT interval or the transmural dispersion of repolarization or increase the incidence of tachycardia. Restriction of medications that adversely affect ion channels and intense vigilance and monitoring during this time and in the postoperative phase could help prevent occurrence or progression of AEs.
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Anesthesia and analgesia · May 2011
Comparative StudyPhysiologic and biologic characteristics of three experimental models of acute lung injury in rats.
Strategies to attenuate ventilator-associated lung injury have been tested in various experimental methods of acute lung injury (ALI). Conclusions are often drawn from physiologic and biologic effects, but the influence of the model on these results is not known. Our aim in this study was to characterize frequently used models of experimental ALI. ⋯ Although comparable physiologic effects meeting acute respiratory distress syndrome criteria were achieved in all models, the biologic responses varied among lung injury models. The acid aspiration model created both respiratory and inflammatory responses typically seen in ALI; these data suggest that it may be the most clinically applicable model to study the intermediate-term effects of ventilator-associated lung injury in rats.
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Anesthesia and analgesia · May 2011
The association between thromboelastographic parameters and total estimated blood loss in patients undergoing elective cesarean delivery.
In this study, we assessed the relationship between coagulation parameters using kaolin-activated thromboelastography (TEG®) and total estimated blood loss (EBL) in patients undergoing elective cesarean delivery (CD). ⋯ There is a weak association between clot strength (as assessed by kaolin-activated TEG®) and EBL in patients undergoing elective CD under neuraxial anesthesia, and a modest reduction in the degree of maternal hypercoagulability occurs in the early postpartum period after elective CD.
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Anesthesia and analgesia · May 2011
Brief report: real-time ultrasound-guided spinal anesthesia using Taylor's approach.
The role of ultrasound scanning in spinal anesthesia is principally limited to preprocedure imaging and identification of anatomical structures. We describe our experience with a real-time ultrasound technique for visualization and performance of spinal anesthesia. ⋯ Subsequently, 10 patients scheduled for joint arthroplasty underwent real-time ultrasound-guided spinal anesthesia in the prone position. The relevant anatomy and the needletip were visualized easily and all spinals were effective for joint arthroplasty.