Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2011
Comparative Study Clinical TrialTransient hemodynamic change and accuracy of arterial blood pressure-based cardiac output.
The purpose of this study was to determine the effects of transient arterial blood pressure change on the accuracy of the FloTrac™/Vigileo™ monitor (Edwards Lifesciences, Irvine, CA). ⋯ The FloTrac/Vigileo measured stroke volume with reasonable accuracy during transient hypotension but overestimated stroke volume during transient hypertension.
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Anesthesia and analgesia · Aug 2011
Multicenter StudyMulticenter assessment of the Iowa Satisfaction with Anesthesia Scale, an instrument that measures patient satisfaction with monitored anesthesia care.
The Iowa Satisfaction with Anesthesia Scale (ISAS) is a questionnaire that measures patient satisfaction with monitored anesthesia care. Previous assessments of the reliability and validity of this tool have been conducted in 2 separate single-center studies. Recently, the questionnaire was used in a 24-center, 315-patient, placebo-controlled trial of dexmedetomidine. We analyzed the data from these patients to provide anesthesiologists and statisticians designing multicenter clinical trials the information needed to use the ISAS as a primary study end point. ⋯ The ISAS is reliable, valid, and useful over the conditions suitable for use as a primary study end point in multicenter clinical trials.
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Anesthesia and analgesia · Aug 2011
ReviewThe clinical implications of isolated alpha(1) adrenergic stimulation.
Phenylephrine is a direct-acting, predominantly α(1) adrenergic receptor agonist used by anesthesiologists and intensivists to treat hypotension. A variety of physiologic studies suggest that α-agonists increase cardiac afterload, reduce venous compliance, and reduce renal bloodflow. The effects on gastrointestinal and cerebral perfusion are controversial. ⋯ Phenylephrine has been studied as an antihypotensive drug in patients with severe aortic stenosis, as a treatment for decompensated tetralogy of Fallot and hypoxemia during 1-lung ventilation, as well as for the treatment of septic shock, traumatic brain injury, vasospasm status-postsubarachnoid hemorrhage, and hypotension during cesarean delivery. In specific instances (critical aortic stenosis, tetralogy of Fallot, hypotension during cesarean delivery) in which the regional effects of phenylephrine (e.g., decreased heart rate, favorable alterations in Q(p):Q(s) ratio, improved fetal oxygen supply:demand ratio) outweigh its global effects (e.g., decreased cardiac output), phenylephrine may be a rational pharmacologic choice. In pathophysiologic states in which no regional advantages are gained by using an α(1) agonist, alternative vasopressors should be sought.
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Anesthesia and analgesia · Aug 2011
Clinical TrialCardiac index in term pregnant women in the sitting, lateral, and supine positions: an observational, crossover study.
Aortocaval compression may affect maternal hemodynamic indices and fetal well-being in various maternal positions. There has been much debate regarding the optimal position for performing neuraxial blockade for labor analgesia and cesarean delivery. We hypothesized that in pregnant women at term, cardiac index (CI) may be improved in the lateral positions as compared with the flexed sitting position. Our primary outcome was to measure CI as assessed by suprasternal Doppler. ⋯ Positioning for neuraxial anesthesia may influence maternal hemodynamic variables. We found no difference in healthy fetal blood flow indices among positions, suggesting that these changes are not clinically significant. This study provides new physiological information on the changes that occur in a group in whom it has not been practical to study previously. Further study is necessary to determine whether these changes are significant in the presence of neuraxial anesthesia or in the high-risk parturient.
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Anesthesia and analgesia · Aug 2011
Automatic notifications mediated by anesthesia information management systems reduce the frequency of prolonged gaps in blood pressure documentation.
Arterial blood pressure (BP) measurement at least every 5 minutes is part of the American Society of Anesthesiologists' monitoring standard, but prolonged BP gaps in electronic anesthesia records have been noted. We undertook multicenter studies to determine the frequency of cases with at least 1 interval ≥10 minutes between successive BP measurements and then to ascertain whether educational feedback via an electronic, near real-time notification system alerting providers to the presence of such gaps would reduce their incidence. ⋯ BP gaps of ≥10 minutes were common in electronic anesthesia records, and their incidence was reduced but not eliminated by near real-time feedback to providers. The American Society of Anesthesiologists' standard for BP documentation every 5 minutes might not be achievable with current practices and technology. Anesthesia information management systems users need to be cognizant of the potential for gaps in BP measurement, take steps to minimize their occurrence, and document an explanation when such failures occur.