Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2016
Implications of Patient Age and ASA Physical Status for Operating Room Management Decisions.
In elderly, high-risk patients, operating room (OR) turnaround times are especially difficult to estimate, and the managerial implications of patient age and ASA physical status for OR management decisions remain unclear. We hypothesized that evaluating patient age and ASA physical status in the right model would improve accuracy of turnaround time estimates and, thus, would have decisive implications for OR management. ⋯ The decision tables allow OR managers at our hospital to schedule procedures more accurately. Evaluation of patient age and ASA physical status as variables can help to better predict turnaround times, which can facilitate scheduling, for example, to schedule overlapping induction rooms, to reduce overutilized OR time by optimizing allocation of patients to several ORs, and to improve logistics of prioritizing transportation of advanced age/high ASA physical status patients to the OR.
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Anesthesia and analgesia · Apr 2016
Comparative StudyFast Versus Slow Recruitment Maneuver at Different Degrees of Acute Lung Inflammation Induced by Experimental Sepsis.
Large tidal volume (VT) breaths or "recruitment maneuvers" (RMs) are used commonly to open collapsed lungs, but their effectiveness may depend on how the RM is delivered. We hypothesized that a stepped approach to RM delivery ("slow" RM) compared with a nonstepped ("fast" RM), when followed by decremental positive end-expiratory pressure (PEEP) titration to lowest dynamic elastance, would (1) yield a more homogeneous inflation of the lungs, thus reducing the PEEP obtained during post-RM titration; (2) produce less lung morphofunctional injury, regardless of the severity of sepsis-induced acute lung inflammation; and (3) result in less biological damage in severe, but not in moderate, acute lung inflammation. ⋯ Compared with CPAPRM, STEPRM reduced biological markers associated with endothelial cell damage and ultrastructural endothelial cell injury in both moderate and severe sepsis-induced acute lung inflammation.
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Anesthesia and analgesia · Apr 2016
The Effects of Short-Term Propofol and Dexmedetomidine on Lung Mechanics, Histology, and Biological Markers in Experimental Obesity.
Administering anesthetics to the obese population requires caution because of a variety of reasons including possible interactions with the inflammatory process observed in obese patients. Propofol and dexmedetomidine have protective effects on pulmonary function and are widely used in short- and long-term sedation, particularly in intensive care unit settings in lean and obese subjects. However, the functional and biological effects of these drugs in obesity require further elucidation. In a model of diet-induced obesity, we compared the short-term effects of dexmedetomidine versus propofol on lung mechanics and histology, as well as biological markers of inflammation and oxidative stress modulation in obesity. ⋯ In this model of diet-induced obesity, a 1-hour propofol infusion yielded increased airway resistance, atelectasis, and lung inflammation, with depletion of antioxidative enzymes. However, unlike sodium thiopental and propofol, short-term infusion of dexmedetomidine had no impact on lung morphofunctional and biological variables.
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Anesthesia and analgesia · Apr 2016
Ultrasound Assessment of the Prokinetic Effect of Erythromycin in Trauma Patients with a Full Stomach: A Case Series.
In this preliminary prospective noninterventional study, we assessed the prokinetic effect of 3 mg•kg erythromycin in nonfasted emergency trauma patients. Ultrasonographic measurements of the antral area were performed 30 minutes and immediately before the erythromycin infusion and serially at 30, 60, and 90 minutes after the start of the infusion. Gastric emptying rates before and after erythromycin infusion, and at each 30-minute period after erythromycin infusion, were then calculated. We found that gastric emptying rates were increased after erythromycin infusion although gastric content and volume remained similar.