Anesthesia and analgesia
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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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Surveys suggest that, consistent with a high smoking prevalence, Chinese smokers in the general population report little interest in quitting. In other cultures, surgery is a powerful teachable moment for smoking cessation, increasing the rate of spontaneous quitting. We determined the perioperative tobacco use behavior of Chinese patients scheduled for elective surgery who smoke cigarettes and factors associated with both preoperative intent to abstain and self-reported smoking behavior at 30 days postoperatively. Specifically, we tested the hypothesis that perception of the health risks of smoking would be independently associated with both preoperative intent to abstain and self-reported abstinence at 30 days postoperatively. ⋯ Both intent to quit and self-efficacy for maintaining abstinence appear to be much higher in Chinese surgical patients than in prior surveys of the general Chinese population, and the majority of surgical patients maintained abstinence for at least 30 days. These findings suggest that surgery can serve as a powerful teachable moment for smoking cessation in China.
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Anesthesia and analgesia · Jun 2013
Randomized Controlled TrialBrief report: perioperative analgesic efficacy and plasma concentrations of S+ -ketamine in continuous epidural infusion during thoracic surgery.
In our study, we evaluated the analgesic effect and plasma level time course of subanesthetic doses of intraoperative S(+)-ketamine administered by continuous epidural infusion for postthoracotomic pain. ⋯ Our data show that epidural infusion of subanesthetic doses of S(+)-ketamine during thoracic surgery provides better postoperative analgesia than epidural ropivacaine.
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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
Intrathecal pain pump infusions for intractable cancer pain: an algorithm for dosing without a neuraxial trial.
Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an intrathecal pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial intrathecal pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay. ⋯ When an epidural trial is not feasible and an intrathecal pump is required in a cancer patient, it is possible to predict an initial dose for the intrathecal pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home.