Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2015
Practice GuidelineNational Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage.
Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. ⋯ Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation.
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Anesthesia and analgesia · Jul 2015
The Incidence of Perioperative Hypersensitivity Reactions: A Single-Center, Prospective, Cohort Study.
The incidence of perioperative hypersensitivity reactions, which can be life-threatening, ranges from 1 in 20,000 to 1 in 1361. These reactions are usually classified as IgE or non-IgE mediated. The aim of this study was to determine the incidence of allergic reactions during general anesthesia in our hospital, to establish the incidence of the allergic reactions for each drug used, to assess the frequency of IgE-mediated reactions in even mild reactions, and to compare the degree of agreement between anesthesiologist suspicion and allergy diagnosis. ⋯ Perioperative reactions are more common than previously reported. Mild hypersensitivity perioperative reactions-involving only skin-should be considered in evaluating patients because a substantial number of these reactions are IgE mediated.
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Anesthesia and analgesia · Jul 2015
Elective Endovascular Treatment of Unruptured Intracranial Aneurysms: A Management Case Series of Patient Outcomes After Institutional Change to Admit Patients Principally to Postanesthesia Care Unit Rather Than to Intensive Care.
Our intention in this case series was to review the postoperative care and neurologic outcomes of patients who had undergone elective endovascular treatment of unruptured intracranial aneurysms. The case series is unique managerially in that a progressively increasing percentage of patients were admitted to the postanesthesia care unit (PACU; 1:2 nurse-to-patient ratio) and subsequently to the neurosurgical ward (1:3 nurse-to-patient ratio) instead of directly to the intensive care unit (ICU; 1:1 nurse-to-patient ratio). ⋯ In centers in which PACU and ward care are comparable to those in this case series, in the absence of intraoperative events with the potential for ongoing cerebral ischemia, most patients undergoing elective endovascular treatment of unruptured cerebral aneurysms can be managed without direct ICU admission. Scheduling all these procedures by using the mean historical anesthesia duration is reasonable.
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Anesthesia and analgesia · Jul 2015
ReviewPersonalizing Pediatric Pain Medicine: Using Population-Specific Pharmacogenetics, Genomics, and Other -Omics Approaches to Predict Response.
Personalized medicine is the science of individualized prevention and therapy. The notion that "one size fits all" has been replaced by the idea of patient-tailored health care. Within this paradigm, the research community has turned to examine genetic predictors of disease and treatment responses. ⋯ Simultaneously, there is an increased recognition regarding the complexity of pain research, acknowledging the additional role of epigenetic, transcriptomic, proteomic, and metabolomic factors in the development, experience, and treatment of pain. This article provides an introduction to population-specific pharmacogenetics, proteomics and other "-omics" technologies to predict drug response to pain medications in children. It aims to provide anesthesiologists with the basic knowledge to understand the potential implications of genetic and epigenetic factors managing the pain of pediatric patients.
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Anesthesia and analgesia · Jul 2015
Observational StudyMonitoring Cerebral Autoregulation After Brain Injury: Multimodal Assessment of Cerebral Slow-Wave Oscillations Using Near-Infrared Spectroscopy.
Continuous monitoring of cerebral autoregulation might provide novel treatment targets and identify therapeutic windows after acute brain injury. Slow oscillations of cerebral hemodynamics (0.05-0.003 Hz) are visible in multimodal neuromonitoring and may be analyzed to provide novel, surrogate measures of autoregulation. Near-infrared spectroscopy (NIRS) is an optical neuromonitoring technique, which shows promise for widespread clinical applicability because it is noninvasive and easily delivered across a wide range of clinical scenarios. The aim of this study is to identify the relationship between NIRS signal oscillations and multimodal neuromonitoring, examining the utility of near infrared derived indices of cerebrovascular reactivity. ⋯ Although slow-wave activity in intracranial pressure, transcranial Doppler, and NIRS is significantly similar, it varies dynamically in both time and frequency, and this manifests as incomplete agreement between reactivity indices. Analysis informed by a priori knowledge of physiology underpinning NIRS variables combined with sophisticated analysis techniques has the potential to deliver noninvasive surrogate measures of autoregulation, guiding therapy.