Anesthesia and analgesia
-
Much more than a telephone, today's mobile device has become an integral part of the way we interface with the world. Mobile devices have the computing capability, display, and battery power to become powerful medical devices that measure vital signs and provide intelligent interpretation or immediate transmission of information. ⋯ This readily available computing power will also extend the utility of vital signs monitoring to new clinical indications, especially with the use of additional processing and integration of information. This review will focus on the universal promotion of pulse oximetry and advanced processing of plethysmography to assess variables such as respiratory rate, capillary refill time, and fluid responsiveness, and how these measurements may assist with perioperative monitoring, diagnosis, and management of pneumonia in children and preeclampsia in pregnancy when combined with mobile devices.
-
Anesthesia and analgesia · Oct 2013
EditorialThe Effective Concentration of Tranexamic Acid for Inhibition of Fibrinolysis in Neonatal Plasma In Vitro.
Neonates are at high risk for bleeding complications after cardiovascular surgery. Activation of intravascular fibrinolysis is one of the principal effects of cardiopulmonary bypass that causes poor postoperative hemostasis. Antifibrinolytic medications such as tranexamic acid are often used as prophylaxis against fibrinolysis, but concentration/effect data to guide dosing are sparse for adults and have not been published for neonates. Higher concentrations of tranexamic acid than those necessary for inhibition of fibrinolysis may have adverse effects. Therefore, we investigated the concentration of tranexamic acid necessary to inhibit activated fibrinolysis in neonatal plasma. ⋯ Our data establish the minimal effective concentration of tranexamic acid necessary to completely prevent fibrinolysis in neonatal plasma in vitro. These data may be useful in designing a dosing scheme for tranexamic acid appropriate for neonates.
-
Anesthesia and analgesia · Oct 2013
Biography Historical ArticleThomas Linwood Bennett, MD: One of New York City's First Prominent Physician Anesthetists.
Thomas Linwood Bennett (1868-1932) was one of New York City's first prominent physician anesthetists. He was the first dedicated anesthetist at the Hospital for the Ruptured and Crippled, subsequently renamed Hospital for Special Surgery. He subsequently practiced at multiple institutions throughout New York City as one of the first physicians in the United States to dedicate his entire practice to the emerging field of anesthesia. Bennett was considered the preeminent anesthetist of his time, excelling at research, innovation, education, and clinical care.
-
Anesthesia and analgesia · Oct 2013
Rescheduling of Previously Cancelled Surgical Cases Does Not Increase Variability in Operating Room Workload When Cases Are Scheduled Based on Maximizing Efficiency of Use of Operating Room Time.
Conceptually, cancelling a case close to the scheduled day of surgery increases variability in operating room (OR) workload (i.e., total hours of scheduled cases plus turnovers), creating managerial problems. However, in our recent study of an OR scheduling office, cancellations (slightly) reduced variability in workload among days. If a relatively low incidence of cancellations does not cause increased variability in workload, this would be a useful finding when focusing strategic OR management initiatives. However, the previous study considered only the effect on the schedule for the day the cancelled case originally was scheduled to be performed, not the future date on which the case was performed. ⋯ Rescheduled cancelled cases did not increase variability in OR workload. This finding is useful combined with our recent finding that cancellation slightly reduces variability in OR workload on the date of cancellation. Cancellations should not be interpreted as a system failure that increases variability in surgical workload. We recommend that anesthesiologists aim to reduce cancellation rates if above benchmarked averages, but otherwise focus on more strategically beneficial initiatives. We recommend also that these results be considered if cancellation rates are used in assessing anesthesiology group performance.
-
Anesthesia and analgesia · Oct 2013
The Association Between Preoperative Anemia and 30-Day Mortality and Morbidity in Noncardiac Surgical Patients.
Anemia has been associated with increased postoperative morbidity and mortality. We used the American College of Surgeons National Surgical Quality Improvement Program database to retrospectively assess the relationship between preoperative anemia and 30-day postoperative mortality and morbidity in noncardiac surgical patients, careful to distinguish confounding variables from mediator variables. ⋯ Preoperative anemia appears to be associated with baseline diseases that markedly increase mortality. Anemia per se is a rather weak independent predictor of postoperative mortality. Our analysis also illustrates how analyzing large variable-rich registries challenges investigators to discriminate between confounding variables and mediator variables, i.e., factors that might be considered as "causal pathways" for the effect of the exposure or intervention on outcome.