Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2015
Multicenter StudyAssociations Between Age and Dosing of Volatile Anesthetics in 2 Academic Hospitals.
The inverse relationship between age and dose requirement for potent volatile anesthetics is well established, but the question of whether anesthetic providers consider this relationship in practice remains unanswered. We sought to determine whether there is an association between patient age and the mean dose of volatile anesthetic delivered during maintenance of anesthesia. ⋯ Increasing age is associated with decreased absolute doses of potent volatile anesthetics, an association that seems to strengthen as patients enter the geriatric age range. The observed decreases in absolute anesthetic dose were less than those predicted by previous research and therefore represent an overall increase in "age-adjusted dose" as patients grow older.
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Anesthesia and analgesia · Sep 2015
Randomized Controlled TrialVideo Distraction and Parental Presence for the Management of Preoperative Anxiety and Postoperative Behavioral Disturbance in Children: A Randomized Controlled Trial.
The anxiolytic efficacy of video watching, in the absence of parents, during the mask induction of anesthesia in young children with high separation anxiety has not been clearly established. We performed this study to determine whether the effect of video distraction on alleviating preoperative anxiety is independent of parental presence and whether a combination of both interventions is more effective than either single intervention in alleviating preoperative anxiety and postoperative behavioral disturbance in preschool children. ⋯ Video distraction, parental presence, or their combination showed similar effects on preoperative anxiety during inhaled induction of anesthesia and postoperative behavioral outcomes in preschool children having surgery.
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Anesthesia and analgesia · Sep 2015
Observational StudyPostoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study.
The incidence, severity, and duration of postoperative oxygen desaturation in the general surgical population are poorly characterized. We therefore used continuous pulse oximetry to quantify arterial oxygen saturation (SpO2) in a cross-section of patients having noncardiac surgery. ⋯ Hypoxemia was common and prolonged in hospitalized patients recovering from noncardiac surgery. The SpO2 values recorded in medical records seriously underestimated the severity of postoperative hypoxemia.
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Anesthesia and analgesia · Sep 2015
Randomized Controlled TrialDexmedetomidine Improves Intubating Conditions Without Muscle Relaxants in Children After Induction With Propofol and Remifentanil.
Anesthesia induction using propofol (3 mg/kg) and remifentanil (2 μg/kg) without the use of muscle relaxants has been associated with a lower incidence of successful intubation. Dexmedetomidine has been found to effectively decrease the requirements for propofol and remifentanil and to attenuate the hemodynamic response to intubation. Therefore, in this study, we examined intubating conditions and hemodynamic changes in children after induction with dexmedetomidine (1 μg/kg) combined with propofol (3 mg/kg) and remifentanil (2 μg/kg). ⋯ A single dose of dexmedetomidine (1 μg/kg) improved intubation conditions in children after induction with propofol (3 mg/kg) and remifentanil (2 μg/kg) without muscle relaxants. Dexmedetomidine did not affect the hemodynamic response to intubation.
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Anesthesia and analgesia · Sep 2015
ReviewE-mail as the Appropriate Method of Communication for the Decision-Maker When Soliciting Advice for an Intellective Decision Task.
For many problems in operating room and anesthesia group management, there are tasks with optimal decisions, and yet experienced personnel tend to make decisions that are worse or no better than random chance. Such decisions include staff scheduling, case scheduling, moving cases among operating rooms, and choosing patient arrival times. In such settings, operating room management leadership decision-making should typically be autocratic rather than participative. ⋯ Given that the manager is e-mailing an advisor whose competence the manager trusts, it is unnecessary to use a richer communication channel to develop trust. Finally, many of the limitations of e-mail can be rectified through training. We expect that decades from now, e-mail (i.e., asynchronous writing) between an expert and decision-maker will remain the dominant means of communication for intellective tasks.