Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2017
Randomized Controlled TrialRemote Ischemic Preconditioning Decreases Oxidative Lung Damage After Pulmonary Lobectomy: A Single-Center Randomized, Double-Blind, Controlled Trial.
During lobectomy in patients with lung cancer, the operated lung is often collapsed and hypoperfused. Ischemia/reperfusion injury may then occur when the lung is re-expanded. We hypothesized that remote ischemic preconditioning (RIPC) would decrease oxidative lung damage and improve gas exchange in the postoperative period. ⋯ Limb RIPC decreased EBC 8-isoprostane levels and other oxidative lung injury markers during lung lobectomy. RIPC also improved postoperative gas exchange as measured by PaO2/FiO2 ratio.
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Anesthesia and analgesia · Aug 2017
Randomized Controlled TrialA Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation.
In patients with cervical immobilization, jaw thrust can cause cervical spine movement. Concurrent use of a laryngoscope may facilitate lightwand intubation, allowing midline placement and free movement of the lightwand in the oral cavity without jaw thrust. We compared the effects of laryngoscope-assisted lightwand intubation (LALI) versus conventional lightwand intubation (CLI) on cervical spine motion during intubation in patients with simulated cervical immobilization. ⋯ The LALI technique produces less upper cervical spine motion during intubation than the CLI technique in patients with simulated cervical immobilization.
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Anesthesia and analgesia · Aug 2017
Factors Associated With Missed Appointments at an Academic Pain Treatment Center: A Prospective Year-Long Longitudinal Study.
Interventional pain treatment centers represent an integral part of interdisciplinary care. Barriers to effective treatment include access to care and financial issues related to pain clinic operations. To address these challenges, specialty clinics have taken steps to identify and remedy missed clinic appointments. However, no prospective study has sought to identify factors associated with pain clinic "no-shows." ⋯ We found a high no-show rate, which was associated with predictable and unpredictable (eg, snow) factors. Steps to reduce the no-show rate are discussed. To maximize access to care, operation managers should consider a regression model that accounts for patient-level risk of predictable no-shows. Knowing the patient level, no-show rate can potentially help to optimize the schedule programming by staggering low- versus high-probability no-shows.
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Anesthesia and analgesia · Aug 2017
Defining the Primary Outcomes and Justifying Secondary Outcomes of a Study: Usually, the Fewer, the Better.
One of the first steps in designing and conducting a research study is identifying the primary and any secondary study outcomes. In an experimental, quasi-experimental, or analytic observational research study, the primary study outcomes arise from and align directly with the primary study aim or objective. Likewise, any secondary study outcomes arise from and directly align with any secondary study aim or objective. ⋯ A composite endpoint is an endpoint consisting of several outcome variables that are typically correlated with each. In designing a study, researchers limit components of a composite endpoint to variables on which the intervention of interest would most plausibly have an effect, and optimally with preliminary evidence of an effect. Ideally, components of a strong composite endpoint have similar treatment effect, frequency, and severity-with the most important being similar severity.
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Anesthesia and analgesia · Aug 2017
Observational StudyRisk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies.
Women who undergo intrapartum caesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH) compared with those undergoing prelabor CD. To determine whether the presence and strength of the associations between individual risk factors and severe PPH vary among women undergoing prelabor CD or intrapartum CD, stratified analyses are needed according to CD subtype. ⋯ Women who undergo prelabor CD and intrapartum CD have several shared risk factors for severe PPH (general anesthesia and multiple pregnancies). However, the risk factor profiles for severe PPH differed between these CD cohorts. Recognizing these differences may be important when planning resources and interventions for high-risk patients undergoing either prelabor or intrapartum CD.