Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2011
Self-reported information needs of anesthesia residency applicants and analysis of applicant-related web sites resources at 131 United States training programs.
Despite the use of web-based information resources by both anesthesia departments and applicants, little research has been done to assess these resources and determine whether they are meeting applicant needs. Evidence is needed to guide anesthesia informatics research in developing high-quality anesthesia residency program Web sites (ARPWs). ⋯ Anesthesia residency applicants rely heavily on ARPWs to research programs, prepare for interviews, and formulate a rank list. Anesthesia departments can improve their ARPWs by including information such as total hours worked and work hours by rotation (missing in 96% and 97% of ARPWs) and providing a valid web address on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) (missing in 28% of ARPWs).
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Anesthesia and analgesia · Feb 2011
Do 0-10 numeric rating scores translate into clinically meaningful pain measures for children?
Self-reported pain scores are used widely in clinical and research settings, yet little is known about their interpretability in children. In this prospective, observational study we evaluated the relationship between 0 to 10 numerical rating scale (NRS) pain scores and other self-reported, clinically meaningful outcomes, including perceived need for medicine (PNM), pain relief (PR), and perceived satisfaction (PS) with treatment in children postoperatively. ⋯ This study provides important information regarding the clinical interpretation of NRS pain scores in children. Data further support the NRS as a valid measure of pain intensity in relation to the child's PNM, PR, and PS in the acute postoperative setting. However, the variability in scores in relation to other clinically meaningful outcomes suggests that application of cut-points for individual treatment decisions is inappropriate.
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Anesthesia and analgesia · Feb 2011
Reinforcement learning: a novel method for optimal control of propofol-induced hypnosis.
Reinforcement learning (RL) is an intelligent systems technique with a history of success in difficult robotic control problems. Similar machine learning techniques, such as artificial neural networks and fuzzy logic, have been successfully applied to clinical control problems. Although RL presents a mathematically robust method of achieving optimal control in systems challenged with noise, nonlinearity, time delay, and uncertainty, no application of RL in clinical anesthesia has been reported.
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Anesthesia and analgesia · Feb 2011
Case ReportsThe possible influence of pulmonary arterio-venous shunt and hypoxic pulmonary vasoconstriction on arterial sevoflurane concentration during one-lung ventilation.
Sevoflurane is widely used for its rapid onset and offset due to a lower blood/gas coefficient. However, involuntary movements, tachycardia, and hypertension have been observed in some patients despite a continuing constantly delivered concentration of sevoflurane during 1-lung ventilation (OLV), indicating the possibility of insufficient depth of anesthesia. We observed a temporary but obvious decrease in arterial sevoflurane concentration and pulse oximeter readings in a patient during OLV. This may have resulted in the depth of inhaled anesthesia being insufficient during OLV because the arterial sevoflurane concentration was lower than expected in spite of constantly delivered and inspiratory/expiratory sevoflurane concentrations.
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Anesthesia and analgesia · Feb 2011
Pulse oximeter plethysmographic waveform changes in awake, spontaneously breathing, hypovolemic volunteers.
The primary objective of this study was to determine whether alterations in the pulse oximeter waveform characteristics would track progressive reductions in central blood volume. We also assessed whether changes in the pulse oximeter waveform provide an indication of blood loss in the hemorrhaging patient before changes in standard vital signs. ⋯ These results support the use of pulse oximeter waveform analysis as a potential diagnostic tool to detect clinically significant hypovolemia before the onset of cardiovascular decompensation in spontaneously breathing patients.