Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2013
The hemodynamic management of 5177 neurosurgical and orthopedic patients who underwent surgery in the sitting or "beach chair" position without incidence of adverse neurologic events.
A small number of highly publicized case reports describe ischemic brain or spinal cord injury after surgery in the sitting ("beach chair") position. The incidence of such catastrophic outcomes remains unknown, as does the relationship between arterial blood pressure management and injury, because few hemodynamic details were included with those 4 cases. To add quantitative data to the discussion of anesthesia in the sitting position, we examined the detailed hemodynamics of a large number of patients managed at our institution who sustained no similar catastrophic outcomes. ⋯ This study provides a descriptive summary of intraoperative blood pressure changes, measured either invasively or noninvasively, and referenced to either head or heart level, but never lower than heart level, in patients under general anesthesia in the sitting position who sustained no catastrophic outcomes.
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Anesthesia and analgesia · Jun 2013
Anesthesiology residents' and nurse anesthetists' perceptions of effective clinical faculty supervision by anesthesiologists.
Often anesthesia care is provided by nonfaculty anesthesia providers (e.g., anesthesiology residents and certified registered nurse anesthetists [CRNAs]) under the guidance of faculty anesthesiologists. Performance appraisal of faculty anesthesiologists should therefore include evaluation of this guidance. ⋯ Most CRNAs and residents at 3 teaching hospitals considered faculty guidance that meets expectations to be at least "frequent," regardless of years in practice.
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Anesthesia and analgesia · Jun 2013
The protective effects of volatile anesthestics against the bronchoconstriction induced by an allergic reaction in sensitized rabbit pups.
Volatile inhaled anesthetics exert a differential protective effect against bronchospasm development after cholinergic stimulation. However, their ability to inhibit the adverse respiratory consequences of an anaphylactic reaction after exposure to an allergen has not been characterized. We therefore compared the abilities of isoflurane, sevoflurane, and desflurane to prevent the lung constriction induced by an allergic reaction in a pediatric model of an anaphylactic reaction. ⋯ Our results reveal the lack of potential of the commonly used volatile anesthetics to inhibit the most severe acute phase of the constrictor response to allergen after anaphylaxis in both the central airway and peripheral lung compartments. Inhalation of volatile anesthetics, particularly sevoflurane, promotes an earlier easing of the bronchospasm; this beneficial profile may be advantageous in children with atopic lung diseases.