Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2012
Randomized Controlled Trial Comparative StudyThe impact of perioperative catastrophes on anesthesiologists: results of a national survey.
Most anesthesiologists will experience at least one perioperative catastrophe over the course of their careers. Very little, however, is known about the emotional impact of these events and their effects on both immediate and long-term ability to provide care. In this study, we examined the incidence of perioperative catastrophes and the impact of these outcomes on American anesthesiologists. ⋯ A perioperative catastrophe may have a profound and lasting emotional impact on the anesthesiologist involved and may affect his or her ability to provide patient care in the aftermath of such events.
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Anesthesia and analgesia · Mar 2012
Randomized Controlled Trial Comparative StudyBarriers to adverse event and error reporting in anesthesia.
Although anesthesiologists are leaders in patient safety, there has been little research on factors affecting their reporting of adverse events and errors. First, we explored the attitudinal/emotional factors influencing reporting of an unspecified adverse event caused by error. Second, we used a between-groups study design to ask whether there are different perceived barriers to reporting a case of anaphylaxis caused by an error compared with anaphylaxis not caused by error. Finally, we examined strategies that anesthesiologists believe would facilitate reporting. Where possible, we contrasted our results with published findings from other physician groups. ⋯ The majority of anesthesiologists in our study did not agree that the attitudinal/emotional barriers surveyed would influence reporting of an unspecified adverse event caused by error, with the exception of the barrier of being concerned about blame by colleagues. The probable influence of 6 perceived barriers to reporting a specified adverse event of anaphylaxis differed with the presence or absence of error. Anesthesiologists in our study supported assistive reporting strategies. There seem to be some differences between our results and previously published research for other physician groups.
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Anesthesia and analgesia · Mar 2012
Randomized Controlled Trial Comparative StudyPartner's presence during initiation of epidural labor analgesia does not decrease maternal stress: a prospective randomized controlled trial.
Epidural analgesia reduces pain and anxiety during childbirth. In this randomized controlled trial, we sought to determine whether partner presence during the initiation of epidural analgesia reduces stress of both the mother and her partner and their perception of maternal pain. ⋯ Partner presence during epidural catheter insertion for labor analgesia did not decrease anxiety levels. To the contrary, anxiety and pain of epidural catheter placement were greater if the partner remained in the room.
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Anesthesia and analgesia · Mar 2012
Randomized Controlled Trial Comparative StudyTeaching aseptic technique for central venous access under ultrasound guidance: a randomized trial comparing didactic training alone to didactic plus simulation-based training.
Our goal was to determine whether simulation combined with didactic training improves sterile technique during ultrasound (US)-guided central venous catheter (CVC) insertion compared with didactic training alone among novices. We hypothesized that novices who receive combined didactic and simulation-based training would perform similarly to experienced residents in aseptic technique, knowledge, and perception of comfort during US-guided CVC insertion on a simulator. ⋯ Simulation combined with didactic training is superior to didactic training alone for acquisition of clinical skills such as US-guided CVC insertion. After combined didactic and simulation-based training, novices can outperform experienced residents in aseptic technique as well as in measurements of knowledge.
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Anesthesia and analgesia · Mar 2012
Randomized Controlled Trial Comparative StudyFresh and stored red blood cell transfusion equivalently induce subclinical pulmonary gas exchange deficit in normal humans.
Transfusion can cause severe acute lung injury, although most transfusions do not seem to induce complications. We tested the hypothesis that transfusion can cause mild pulmonary dysfunction that has not been noticed clinically and is not sufficiently severe to fit the definition of transfusion-related acute lung injury. ⋯ RBC transfusion causes subtle pulmonary dysfunction, as evidenced by impaired gas exchange for oxygen, supporting our hypothesis that lung impairment after transfusion includes a wide spectrum of physiologic derangements and may not require an existing state of altered physiology. These data do not support the hypothesis that transfusion of RBCs stored for >21 days is more injurious than that of fresh RBCs.