Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2015
Observational StudyInteraction Effects of Acute Kidney Injury, Acute Respiratory Failure, and Sepsis on 30-Day Postoperative Mortality in Patients Undergoing -High-Risk Intraabdominal General Surgical Procedures.
Acute kidney injury (AKI), acute respiratory failure, and sepsis are distinct but related pathophysiologic processes. We hypothesized that these 3 processes may interact to synergistically increase the risk of short-term perioperative mortality in patients undergoing high-risk intraabdominal general surgery procedures. ⋯ In high-risk general surgery patients, the development of AKI, acute respiratory failure, or sepsis is independently associated with an increase in 30-day mortality. In addition, the development of 2 complications shows significant positive additive interactions to further increase the risk of mortality. Our findings suggest that interactions between these 3 perioperative complications increase the risk of mortality more than would be expected by the independent effects of each complication alone.
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Anesthesia and analgesia · Dec 2015
Anesthesia Workload Nationally During Regular Workdays and Weekends.
We analyze data from the American Society of Anesthesiologist's (ASA) Anesthesia Quality Institute (AQI) to report the U.S. anesthesia workload by time of day and day of the week. We consider the extent to which first case starts, rather than durations of workdays and weekend cases, influence the number of anesthesia providers nationally. ⋯ The results are inconsistent with widespread use of surgical facilities (i.e., anesthesia providers) in mornings only, especially at University and large community hospitals. The observed national work hours match with what would be expected if most anesthesiologists work at least 8 hours on regular workdays. Opportunity for greater use of the capital (building and equipment) probably would involve the use of additional anesthesia providers representing a second shift or use of weekends.
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Anesthesia and analgesia · Dec 2015
The Influence of Hypovolemia and Fluid Resuscitation During Hemorrhagic Shock on Apneic Oxygen Desaturation After Preoxygenation in a Swine Model.
Patients experiencing major bleeding often require both aggressive fluid resuscitation and rapid sequence tracheal intubation. The influence of hemorrhage-induced hypovolemia, and/or subsequent fluid resuscitation, on the time until critical oxygen desaturation is not well described. We studied the time to oxygen desaturation in a pig model of hemorrhage shock and colloid resuscitation. ⋯ In patients with acute hemorrhagic shock, a hypovolemic state increases the duration of apnea until critical oxygen desaturation. Clinicians should thus consider the relationship between fluid resuscitation and time to desaturation when performing tracheal intubation in such patients.