Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2013
Technical communication: inhaled anesthetic agent-vaporizer mismatch: management in settings with limited resources: don't try this at home.
Agent-specific vaporizers minimize opportunities for error and evidence our specialty's commitment to patient safety as a general principle. End-tidal anesthetic gas concentration monitoring is a useful adjunct whenever inhaled anesthetics are used in operating rooms. Due to their expense and required maintenance, end-tidal anesthetic gas monitors are not commonly used in developing nations. ⋯ Mismatching of inhaled agent and vaporizer is a dangerous practice and should not be performed unless it is absolutely necessary. Such situations may arise in remote locations where neither end-tidal anesthetic gas monitoring nor vaporizer-specific agent is available. We hope our article provides guidance in such situations.
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Anesthesia and analgesia · Jun 2013
Randomized Controlled TrialThe effectiveness of a near-infrared vascular imaging device to support intravenous cannulation in children with dark skin color: a cluster randomized clinical trial.
Poor vein visibility can make IV cannulation challenging in children with dark skin color. In the operating room, we studied the effectiveness of a near-infrared vascular imaging device (VascuLuminator) to facilitate IV cannulation in children with dark skin color. ⋯ The VascuLuminator has limited value in improving success at first attempt of facilitating IV cannulation in children with dark skin color.
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Anesthesia and analgesia · Jun 2013
ReviewReview article: heparin sensitivity and resistance: management during cardiopulmonary bypass.
Heparin resistance during cardiac surgery is defined as the inability of an adequate heparin dose to increase the activated clotting time (ACT) to the desired level. Failure to attain the target ACT raises concerns that the patient is not fully anticoagulated and initiating cardiopulmonary bypass may result in excessive activation of the hemostatic system. Although antithrombin deficiency has generally been thought to be the primary mechanism of heparin resistance, the reasons for heparin resistance are both complex and multifactorial. ⋯ Nevertheless, many clinicians choose a target ACT to assess anticoagulation, and interventions aimed at achieving the target ACT are routinely performed in the setting of heparin resistance. Treatments for heparin resistance/alterations in heparin responsiveness include additional heparin or antithrombin supplementation. In this review, we discuss the variability of heparin potency, heparin responsiveness as measured by the ACT, and the current management of heparin resistance.