Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2013
Characteristics of emergency pages using a computer-based anesthesiology paging system in children and adults undergoing procedures at a tertiary care medical center.
In our large academic supervisory practice, attending anesthesiologists concomitantly care for multiple patients. To manage communications within the procedural environment, we use a proprietary electronic computer-based anesthesiology visual paging system. This system can send an emergency page that instantly alerts the attending anesthesiologist and other available personnel that immediate help is needed. We analyzed the characteristics of intraoperative emergency pages in children and adults. ⋯ Emergency pages were rare in patients older than 2 years. Infants were more likely than children 1 to 2 years of age to have emergency page activation, despite both groups being cared for by pediatric fellowship trained anesthesiologists.
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Anesthesia and analgesia · Apr 2013
Comparative StudyUltrasound estimates for midline epidural punctures in the obese parturient: paramedian sagittal oblique is comparable to transverse median plane.
Spinal ultrasound (US) in the transverse median (TM) plane underestimates the distance to the epidural space in obese pregnant women, most likely because of compression of the subcutaneous tissue during the assessment, often required to compensate for poor visibility. We tested whether scanning in the paramedian sagittal oblique (PSO) plane compared with the TM plane resulted in a more precise estimate of the actual skin-epidural space measurement in this population. ⋯ The estimates of the US-determined distance to the epidural space in the PSO are comparable to those in the TM plane. The ability to use both estimates interchangeably for midline punctures may prove useful in patients presenting with poor visibility in the TM plane.
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Anesthesia and analgesia · Apr 2013
The anesthetic effects on vasopressor modulation of cerebral blood flow in an immature swine model.
The effect of various sedatives and anesthetics on vasopressor modulation of cerebral blood flow (CBF) in children is unclear. In adults, isoflurane has been described to decrease CBF to a lesser extent than fentanyl and midazolam. Most large-animal models of neurocritical care use inhaled anesthetics for anesthesia. Investigations involving modulations of CBF would have improved translatability within a model that more closely approximates the current practice in the pediatric intensive care unit. ⋯ The vasopressor effect on CBF was limited when using a narcotic-benzodiazepine-based anesthetic protocol compared with volatile anesthetics, consistent with a preservation of autoregulation. Selection of anesthetic drugs is critical to investigate mechanisms of cerebrovascular hemodynamics, and in translating critical care investigations between the laboratory and bedside.
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Anesthesia and analgesia · Apr 2013
Choosing which practitioner sees the next patient in the preanesthesia evaluation clinic based on the relative speeds of the practitioner.
When a practitioner in a preanesthesia evaluation clinic is not evaluating a patient because no patient is waiting to be seen, the practitioner often has other responsibilities such as reviewing charts of patients. When practitioners differ in how quickly they complete evaluations, multiple scenarios can be created wherein the slowest practitioner would only evaluate patients when the number of patients waiting exceeds a threshold (e.g., at least 2 patients are waiting). ⋯ Practitioners' speeds in evaluating patients do not differ sufficiently for information systems to be used routinely to choose who evaluates the next patient (i.e., state-dependent assignment policy). Clinics aiming to reduce patient waiting should focus on reducing the overall mean evaluation time (e.g., by chart review ahead), appropriately scheduling patients, and having the right numbers of nursing assistants and practitioners.
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Anesthesia and analgesia · Apr 2013
Neurogenic pulmonary edema in patients with nontraumatic intracerebral hemorrhage: predictors and association with outcome.
Neurogenic pulmonary edema (NPE) is a well-recognized phenomenon after intracranial insult. In this study, we evaluated the predictors for NPE and its association with outcome in patients with intensive care unit-treated nontraumatic intracranial hemorrhage. ⋯ Predictors for NPE are the severity of disease defined by APACHE II scores and higher levels of systemic inflammatory mediators. NPE is associated with a higher 1-year mortality, but not with a poorer 1-year functional outcome.