Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2013
How to Improve the Performance of Intraoperative Risk Models: An Example with Vital Signs Using the Surgical Apgar Score.
Computerized reviews of patient data promise to improve patient care through early and accurate identification of at-risk and well patients. The significance of sampling strategy for patient vital signs data is not known. In the instance of the surgical Apgar score (SAS), we hypothesized that larger sampling intervals would improve the specificity and overall predictive ability of this tool. ⋯ When vital signs data are recorded in compliance with American Society of Anesthesiologists' standards, the sampling strategy for vital signs significantly influences performance of the SAS. Computerized reviews of patient data are subject to the choice of sampling methods for vital signs and may have the potential to be optimized for safe, efficient patient care.
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Anesthesia and analgesia · Dec 2013
The effect of lipid emulsion on intracellular bupivacaine as a mechanism of lipid resuscitation: an electrophysiological study using voltage-gated proton channels.
Lipid resuscitation has become a standard treatment for local anesthetic (LA) systemic toxicity, but its mechanisms remain to be fully elucidated. Although the partitioning effect is one of the proposed mechanisms, it is difficult to evaluate its impact independently from several other mechanisms or to examine the intracellular concentration of a LA, which is primarily responsible for LA systemic toxicity. We recently reported that LAs as weak bases reduced voltage-gated proton currents by increasing intracellular pH, which could be estimated from the reversal potentials of the channels (Vrev). Using this characteristic, we examined the partitioning effect in detail and showed its impact on lipid resuscitation. ⋯ Here we quantitatively evaluated for the first time the partitioning effect of lipid emulsion therapy on the intracellular concentration of bupivacaine in real-time settings by analyzing behaviors of voltage-gated proton channels. Our results suggested that lipid emulsion markedly reduced the intracellular concentration of bupivacaine, which was mostly due to the partitioning effect. This could contribute to our understanding of the mechanisms underlying lipid resuscitation, especially the importance of the partitioning effect.
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Anesthesia and analgesia · Dec 2013
Increased mean time from end of surgery to operating room exit in a historical cohort of cases with prolonged time to extubation.
Prolonged time to extubation has been defined as the occurrence of a ≥ 15-minute interval from the end of surgery to removal of the tracheal tube. We quantified the increases in the mean times from end of surgery to exit from the OR associated with prolonged extubations and tested whether the increases were economically important (≥ 5 minutes). ⋯ We recommend that anesthesia providers document the times of extubations and monitor the incidence of prolonged extubations as an economic measure. This would be especially important for providers at facilities with many ORs that have at least 8 hours of cases and turnovers.
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Anesthesia and analgesia · Dec 2013
Historical ArticleThe development and historical context of the datta short laryngoscope handle.
The hormonal, physiologic, and anatomic changes of pregnancy have a number of significant anesthetic implications, including the potential for difficulties and failures in tracheal intubation. The American Society of Anesthesiology closed claims database in the 1970s observed that maternal deaths were involved in 30% of all obstetrics claims, most stemming from difficulty with intubation or ventilation. In the late 1970s, Dr. ⋯ In addition, he observed an increased rate of cesarean delivery and general anesthesia use. These differences led him to evaluate ways in which the laryngoscope itself could be altered to improve the ease of intubation of parturients; this led to the development of the short laryngoscope handle. The genesis of the Datta short laryngoscope handle, and the accompanying historical context, will be explored.
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Anesthesia and analgesia · Dec 2013
Editorial CommentThe quality chasm is even bigger than we thought.