Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2012
Randomized Controlled Trial Multicenter StudyMultiple reservoirs contribute to intraoperative bacterial transmission.
Intraoperative stopcock contamination is a frequent event associated with increased patient mortality. In the current study we examined the relative contributions of anesthesia provider hands, the patient, and the patient environment to stopcock contamination. Our secondary aims were to identify risk factors for stopcock contamination and to examine the prior association of stopcock contamination with 30-day postoperative infection and mortality. Additional microbiological analyses were completed to determine the prevalence of bacterial pathogens within intraoperative bacterial reservoirs. Pulsed-field gel electrophoresis was used to assess the contribution of reservoir bacterial pathogens to 30-day postoperative infections. ⋯ Bacterial contamination of patients, provider hands, and the environment contributes to stopcock transmission events, but the surrounding patient environment is the most likely source. Stopcock contamination is associated with increased patient mortality. Patient and provider bacterial reservoirs contribute to 30-day postoperative infections. Multimodal programs designed to target each of these reservoirs in parallel should be studied intensely as a comprehensive approach to reducing intraoperative bacterial transmission.
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Anesthesia and analgesia · Jun 2012
Case ReportsSpinal cord ischemia occurring in association with induced hypotension for colonic surgery.
A 19-year-old woman underwent an ileoanal pull-through. Intraoperatively, deepening of anesthesia was associated with reduced bleeding. ⋯ Postoperatively, the patient was paraplegic with spinal cord infarction on magnetic resonance imaging from T9 to the tip of the conus medullaris. The collateralization of the anterior spinal artery is very variable and it seems likely that in this individual induced hypotension was associated with inadequate blood flow in the distribution of the artery of Adamkiewicz.
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Anesthesia and analgesia · Jun 2012
Hemodynamic stability after intraarterial injection of verapamil for cerebral vasospasm.
Vasospasm after subarachnoid hemorrhage is a common and potentially life-threatening complication. Treatment of vasospasm may include intraarterial (IA) injections of verapamil into the cerebral vasculature. Clinical experience suggests that the average patient experiences an acute reduction in systemic blood pressure after IA verapamil. Our study objective was to (1) identify the effects of IA injection of verapamil on mean arterial blood pressure (MAP) and heart rate (HR) in patients with cerebral vasospasm and (2) determine the effect of verapamil dose on change in MAP and HR. We hypothesized that (1) selective IA injection of verapamil for treatment of cerebral vasospasm is associated with a reduction in MAP and an increase in HR and (2) the change in MAP and HR are linearly related to the dose of verapamil administered. ⋯ Under general anesthesia, injection of IA verapamil into cerebral arteries reduces MAP but does not change HR in the average patient. Further research is required to determine the clinical significance of these results.
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Anesthesia and analgesia · Jun 2012
WebcastsPreoperative pulse pressure and major perioperative adverse cardiovascular outcomes after lower extremity vascular bypass surgery.
Preoperative increased pulse pressure (PP) has been found to be a predictor of major adverse cardiovascular events (MACEs) after coronary artery bypass graft surgery. In this study, we evaluated the predictive ability of increased preoperative PP to identify MACEs in patients with peripheral vascular disease undergoing lower extremity vascular bypass surgery. ⋯ Preoperative increase in PP is not a predictor of adverse cardiovascular outcomes in patients having lower extremity revascularization surgery.