Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2020
Preemptive and Preventive Pain Psychoeducation and Its Potential Application as a Multimodal Perioperative Pain Control Option: A Systematic Review.
The common treatment for postoperative pain is prescription opioids. Yet, these drugs have limited effect in preventing chronic pain from surgical intervention and have in part contributed to the opioid epidemic. Recently, preemptive analgesia and multimodal analgesia have been proposed with widely gained acceptance in addressing the pain issues. ⋯ The content and presentation of preemptive psychoeducation can help patients form accurate expectations and address their concerns of surgical outcome, leading to a significant decrease in patients' anxiety levels. By addressing the psychological needs of patients through preoperative education, one can decrease postoperative recovery time and postsurgical acute pain. Reduced postsurgical acute pain results in fewer opioid prescriptions, which theoretically lowers the patient's risk of developing chronic postsurgical pain (CPSP), and potentially offers a novel concept using preemptive pain psychoeducation as a part of multimodal pain management solution to the opioid epidemic.
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Anesthesia and analgesia · Mar 2020
Continuous Noninvasive Hemoglobin Monitoring Reflects the Development of Acute Hemodilution After Consecutive Fluid Challenges.
Consecutive fluid challenges (FCs) are frequently administered to maximize the stroke volume (SV) as part of a goal-directed therapy (GDT) strategy. However, fluid administration may also cause acute hemodilution that might lead to an actual paradoxical decrease in oxygen delivery (DO2). The aim of this study was to examine whether continuous noninvasive hemoglobin (SpHb) monitoring can be used to detect the development of acute hemodilution after graded fluid administration. ⋯ Fluid loading aimed at increasing the SV and the DO2 as part of GDT strategy is associated with acute significant decreases in both BHb and SpHb concentrations. When the administration of an FC is not followed by a significant increase (≥10%) in the SV, the DO2 decreases significantly due to the development of acute hemodilution. Continuous noninvasive monitoring of SpHb does not reflect accurately absolute BHb values, but may be reliably used to detect the development of acute hemodilution especially after the administration of at least 500 mL of colloids.
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Anesthesia and analgesia · Mar 2020
Practical Training of Anesthesia Clinicians in Electroencephalogram-Based Determination of Hypnotic Depth of General Anesthesia.
Electroencephalographic (EEG) brain monitoring during general anesthesia provides information on hypnotic depth. We hypothesized that anesthesia clinicians could be trained rapidly to recognize typical EEG waveforms occurring with volatile-based general anesthesia. ⋯ A brief training session was associated with improvements in clinicians without prior EEG training in (1) identifying EEG waveforms corresponding to different hypnotic depths and (2) recognizing when the hypnotic depth suggested by the EEG was discordant with the pEEG index.
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Anesthesia and analgesia · Mar 2020
Comparative StudyComputer Program for Error Grid Analysis in Arterial Blood Pressure Method Comparison Studies.
We recently proposed continuous error grid analysis to describe the clinical relevance of measurement differences between a test and a reference method for arterial blood pressure (AP) measurement. Here, we present instructions on how to perform continuous error grid analysis in AP method comparison studies and provide a freely accessible computer program for automated computing of continuous error grids and calculation of the proportion of measurement pairs in the different risk zones.
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Anesthesia and analgesia · Mar 2020
Comparative StudyTiming and Risk Factors Associated With Postoperative Stroke in Vascular Surgery Patients Using Time-Varying Coefficients From a Cox Model.
Mechanisms of postoperative stroke are poorly understood, particularly for strokes occurring after uneventful emergence from anesthesia. We sought to create a model to study retrospectively the timing and associations for stroke in a high-risk surgery population. ⋯ After adjusting for confounding, stroke was more common and occurred earlier in the CV group. Factors associated with delayed postoperative stroke include acute renal failure, emergent procedures, female sex, preoperative mechanical ventilation, and perioperative transfusion.