Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2015
Randomized Controlled TrialDouble Gloves: A Randomized Trial to Evaluate a Simple Strategy to Reduce Contamination in the Operating Room.
Wearing double gloves during intubation then removing the outer set, may reduce contamination of the intraoperative anesthesia environment.
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Anesthesia and analgesia · Apr 2015
ReviewAnesthetic management during cardiopulmonary bypass: a systematic review.
Cardiopulmonary bypass (CPB) required for cardiac surgery presents unique challenges to the cardiac anesthesiologist responsible for providing the 3 most basic facets of any anesthetic: amnesia, analgesia, and muscle relaxation. Unique pathophysiologic changes during CPB result in pharmacokinetic alterations that impact the serum and tissue concentrations of IV and volatile anesthetics. Similarly, CPB causes pharmacodynamic alterations that impact anesthetic efficacy. ⋯ The magnitude of these challenges is reflected in the higher incidence of intraoperative awareness during cardiac surgery. Further complicating matters are the lack of specific clinical guidelines and varying international policies regarding medical device specifications that add further layers of complexity and introduce practice variability both within institutions and among nations. We performed a systematic survey of the literature to identify where anesthetic practice during CPB is evidence based (or not), identify gaps in the literature to guide future investigations, and explore the implications of evolving surgical practice, perfusion techniques, and national policies that impact amnesia, analgesia, and muscle relaxation during CPB.
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Anesthesia and analgesia · Apr 2015
ReviewVentricular tachycardia ablation: a comprehensive review for anesthesiologists.
Percutaneous catheter ablation is being increasingly performed in patients with recurrent ventricular tachycardia (VT) unresponsive to medical treatment. Optimal management of patients requires careful consideration of the severity of the underlying cardiac disease, the anesthetic drug interactions, and the procedural technique during VT mapping and ablation. ⋯ Furthermore, maintaining hemodynamic stability and monitoring for adequate end-organ perfusion are additional challenges. In this review, we provide a comprehensive update on the currently performed VT ablation procedures and their anesthetic considerations.
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Anesthesia and analgesia · Apr 2015
ReviewAdministration of parenteral prophylactic Beta-lactam antibiotics in 2014: a review.
The role of the anesthesiologist in reducing the incidence of surgical-site infections by the administration of prophylactic parenteral beta-lactam antibiotics is reviewed. Suggestions are made with regard to timing, dosing, and method of administration of these drugs to potentially reduce the risk of surgical-site infection.
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Anesthesia and analgesia · Apr 2015
Observational StudyExtracorporeal Membrane Oxygenation Induces Short-Term Loss of High-Molecular-Weight von Willebrand Factor Multimers.
High-molecular-weight (HMW) von Willebrand factor (vWF) multimers are crucial for primary hemostasis. Increased shear stress from ventricular assist devices can provoke premature degradation of HMW vWF multimers. Whether similar loss of vWF multimers occurs during extracorporeal membrane oxygenation (ECMO) is not clear. ⋯ Loss of HMW vWF multimer bands occurred in patients undergoing ECMO support and resolved after the termination of ECMO. Although not detectable with coagulation screening tests, a vWF:RCo/vWF:Ag ratio <0.7 during ECMO was highly indicative for loss of HMW vWF multimers. Our findings may at least in part explain increased bleeding tendency during ECMO therapy. Administration of vWF concentrates may support restoration of primary hemostasis in patients with relevant bleeding during ECMO support.