Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2011
Multicenter StudyLack of effectiveness of the pulmonary artery catheter in cardiac surgery.
The pulmonary artery catheter (PAC) continues to be used for monitoring of hemodynamics in patients undergoing coronary artery bypass graft (CABG) surgery despite concerns raised in other settings regarding both effectiveness and safety. Given the relative paucity of data regarding its use in CABG patients, and given entrenched practice patterns, we assessed the impact of PAC use on fatal and nonfatal CABG outcomes as practiced at a diverse set of medical centers. ⋯ Use of a PAC during CABG surgery was associated with increased mortality and a higher risk of severe end-organ complications in this propensity-matched observational study. A randomized controlled trial with defined hemodynamic goals would be ideal to either confirm or refute our findings.
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Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Multicenter Study Comparative StudyThe impact of anesthesia on glycine absorption in operative hysteroscopy: a randomized controlled trial.
Operative hysteroscopy requires the use of a distension medium and its absorption can lead to serious consequences from intravascular volume overload and water intoxication. We compared the impact of 2 types of anesthesia (general anesthesia and local anesthesia with sedation) on the absorption of glycine solution in operative hysteroscopy. ⋯ Compared with general anesthesia, local anesthesia with sedation is associated with less glycine absorption and should be considered the preferred method of anesthesia for operative hysteroscopy.
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Anesthesia and analgesia · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyA randomized, open-label study of the safety and tolerability of fospropofol for patients requiring intubation and mechanical ventilation in the intensive care unit.
Current drugs for induction and maintenance of sedation in mechanically ventilated patients in the intensive care unit have limitations. Fospropofol, a prodrug of propofol, has not been studied as a sedative in the ICU setting. ⋯ This pilot study suggests that fospropofol, administered in either an infusion/bolus or infusion-only regimen, is tolerable and effective for short-term induction and maintenance of sedation in mechanically ventilated intensive care unit patients.
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Anesthesia and analgesia · Sep 2011
Multicenter Study Comparative StudyThe effect of hospital size and surgical service on case cancellation in elective surgery: results from a prospective multicenter study.
Short-term case cancellation causes frustration for anesthesiologists, surgeons, and patients and leads to suboptimal use of operating room (OR) resources. In many facilities, >10% of all cases are cancelled on the day of surgery, thereby causing major problems for OR management and anesthesia departments. The effect of hospital type and service type on case cancellation rate is unclear. ⋯ When benchmarking cancellation rates among hospitals, comparisons should control for academic institutions having higher incidences of case cancellation than nonacademic hospitals and general surgery services having higher incidences than other services.
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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.