Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2013
Determinants, associations, and psychometric properties of resident assessments of anesthesiologist operating room supervision.
A study by de Oliveira Filho et al. reported a validated set of 9 questions by which Brazilian anesthesia residents assessed faculty supervision in the operating room. The aim of this study was to use this question set to determine whether faculty operating room supervision scores were associated with residents' year of clinical anesthesia training and/or number of specific resident-faculty interactions. We also characterized associations between faculty operating room supervision scores and resident assessments of: (1) faculty supervision in settings other than operating rooms, (2) faculty clinical ability (family choice), and (3) faculty teaching effectiveness. Finally, we characterized the psychometric properties of the de Oliveira Filho etal. question set in an United States anesthesia residency program. ⋯ Supervision scores provided by all residents can be given equal weight when calculating an individual faculty anesthesiologist's mean supervision score. Assessments of supervision, teaching, and quality of clinical care are highly correlated. When the de Oliveira Filho et al. question set is used in a United States anesthesia residency program, supervision scores are highly reliable and dependable when at least 15 residents assess each faculty.
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Anesthesia and analgesia · Jun 2013
The influence of antithrombin substitution on heparin sensitivity and activation of hemostasis during coronary artery bypass graft surgery: a dose-finding study.
Cardiopulmonary bypass is associated with a high degree of hemostatic system activation. Supplementation of antithrombin (AT) may attenuate this activation and increase a patient's susceptibility to heparin. However, the appropriate dosage of AT has not been defined. We sought to determine the dosage of AT concentrate necessary to achieve >100% AT activity at the end of cardiac surgery and the influence of AT on heparin sensitivity. ⋯ High dosages of AT were required to preserve physiologic AT activity during coronary artery bypass graft surgery and to significantly enhance heparin sensitivity, respectively. However, a significant decrease in AT activity, accompanied by high levels of thrombin generation, was encountered up to 5 days postoperatively.
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Anesthesia and analgesia · Jun 2013
Case Reports"Stay, give me your paw." The benefits of family-centered care.
The value of family-centered care in general and subspecialty pediatrics has been well documented in the literature. Translation of these principles into perioperative medicine has its logistical challenges; however, there are theoretical benefits. ⋯ We describe the presence of one such service dog, at the request of our patient, during induction of general anesthesia. Consideration of the service dog as part of our family-centered care model improved the quality of care we provided this anxious teenager and her mother.
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Anesthesia and analgesia · Jun 2013
Letter Historical ArticlePre 1846 illustrations of a patient undergoing surgery during general anesthesia.