Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2015
Randomized Controlled Trial Comparative StudyI-gel™ Versus LMA-Fastrach™ Supraglottic Airway for Flexible Bronchoscope-Guided Tracheal Intubation Using a Parker (GlideRite™) Endotracheal Tube: A Randomized Controlled Trial.
The I-gel (IG) supraglottic airway device is a reliable way to establish an airway. Its large ventilation lumen allows for easy passage of an endotracheal tube. With the use of a flexible bronchoscope, the IG offers a good visualization of the laryngeal inlet. This prospective randomized study aims to compare the success rate of flexible bronchoscope-guided tracheal intubation using either the IG or the LMA-Fastrach (FT) laryngeal masks. ⋯ The use of the IG supraglottic airway device as a conduit for flexible bronchoscope-guided tracheal intubation results in a success rate equivalent to the use of the LMA-FT. However, the IG allows for shorter intubation times and a better visualization of the glottic opening compared with the LMA-FT.
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Anesthesia and analgesia · Aug 2015
Randomized Controlled TrialDexmedetomidine Does Not Affect Evoked Potentials During Spine Surgery.
The effect of dexmedetomidine on evoked potentials (EPs) has not been elucidated. We aimed to investigate the effect of dexmedetomidine on somatosensory, motor, and visual EPs. ⋯ In clinically relevant doses, dexmedetomidine as an adjunct to total IV anesthesia does not seem to alter EPs and therefore can be safely used during surgeries requiring monitoring of EPs.
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Anesthesia and analgesia · Aug 2015
A System for Anesthesia Drug Administration Using Barcode Technology: The Codonics Safe Label System and Smart Anesthesia Manager™
Many anesthetic drug errors result from vial or syringe swaps. Scanning the barcodes on vials before drug preparation, creating syringe labels that include barcodes, and scanning the syringe label barcodes before drug administration may help to prevent errors. In contrast, making syringe labels by hand that comply with the recommendations of regulatory agencies and standards-setting bodies is tedious and time consuming. A computerized system that uses vial barcodes and generates barcoded syringe labels could address both safety issues and labeling recommendations. ⋯ An anesthesia barcode drug administration system resulted in a moderate rate of scanning syringe label barcodes at the time of drug administration. Further, adaptation of the system will be required to achieve a higher utilization rate.
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Anesthesia and analgesia · Aug 2015
Comparative StudyThe Ability of esCCO™ and ECOM™ Monitors to Measure Trends in Cardiac Output During Alveolar Recruitment Maneuver After Cardiac Surgery: A Comparison with the Pulmonary Thermodilution Method.
Alveolar recruitment maneuvers (ARMs) are known to improve perioperative morbidity but can transiently impact cardiac output (CO). This reproducible hemodynamic perturbation creates a clinical opportunity to test multiple devices during acute changes in CO. The objective of this study was to evaluate the ability of 2 minimally invasive CO monitors, the ECOM (Endotracheal Cardiac Output Monitor) and the esCCO (estimated Continuous Cardiac Output), to measure trends in CO during an ARM in postoperative cardiac surgical patients. ⋯ Compared to pulmonary artery catheter thermodilution, both ECOM and esCCO underestimate changes in CO during an ARM in postoperative cardiac surgical patients. However, ΔECco is within the angular limits of acceptable agreement and may be as efficient as invasive arterial pressure monitoring to track CO changes. In contrast, esCCO is not able to adequately track CO in these specific conditions.
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Anesthesia and analgesia · Aug 2015
The Surgical Care Improvement Project Antibiotic Guidelines: Should We Expect More Than Good Intentions?
Since 2006, the Surgical Care Improvement Project (SCIP) has promoted 3 perioperative antibiotic recommendations designed to reduce the incidence of surgical site infections. Despite good evidence for the efficacy of these recommendations, the efforts of SCIP have not measurably improved the rates of surgical site infections. ⋯ We then suggest a reorientation of quality improvement efforts to focus less on reporting, and incentivizing adherence to imperfect metrics, and more on creating local and regional quality collaboratives to educate clinicians about how to improve practice. Ultimately, successful quality improvement projects are behavioral interventions that will only succeed to the degree that they motivate individual clinicians, practicing within a particular context, to do the difficult work of identifying failures and iteratively working toward excellence.