Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2020
ReviewA Guide to Understanding "State-of-the-Art" Basic Research Techniques in Anesthesiology.
Perioperative medicine is changing from a "protocol-based" approach to a progressively personalized care model. New molecular techniques and comprehensive perioperative medical records allow for detection of patient-specific phenotypes that may better explain, or even predict, a patient's response to perioperative stress and anesthetic care. Basic science technology has significantly evolved in recent years with the advent of powerful approaches that have translational relevance. ⋯ This review focuses on 3 important and most likely practice-changing basic science techniques: next-generation sequencing (NGS), clustered regularly interspaced short palindromic repeat (CRISPR) modulations, and inducible pluripotent stem cells (iPSCs). Each technique will be described, potential advantages and limitations discussed, open questions and challenges addressed, and future developments outlined. We hope to provide insight for practicing physicians when confronted with basic science articles and encourage investigators to apply "state-of-the-art" technology to their future experiments.
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Anesthesia and analgesia · Aug 2020
Multicenter StudyIncidence, Prediction, and Causes of Unplanned 30-Day Hospital Admission After Ambulatory Procedures.
Unanticipated hospital admission is regarded as a measure of adverse perioperative patient care. However, previously published studies for risk prediction after ambulatory procedures are sparse compared to those examining readmission after inpatient surgery. We aimed to evaluate the incidence and reasons for unplanned admission after ambulatory surgery and develop a prediction tool for preoperative risk assessment. ⋯ We present an instrument for prediction of unplanned 30-day admission after ambulatory procedures under anesthesia care validated in a statewide cohort comprising academic and nonacademic hospitals as well as ambulatory surgery centers. The instrument may be useful in identifying patients at high risk for 30-day unplanned hospital admission and may be used for benchmarking hospitals, ambulatory surgery centers, and practitioners.
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Anesthesia and analgesia · Aug 2020
ReviewAnnie, Annie! Are You Okay?: Faces Behind the Resusci Anne Cardiopulmonary Resuscitation Simulator.
We investigated the history of Resusci Anne, the well-known cardiopulmonary resuscitation (CPR) simulation trainer. The creation of Resusci Anne began with Peter J. Safar, an accomplished anesthesiologist who experimented with resuscitation of respiration and cardiac function. ⋯ Laerdal, whose early experimentation with soft plastics allowed him to create a human simulator that could be used to teach the skills of resuscitation to both medical care practitioners and individuals of all walks of life. A special face was chosen for the simulation mannequin, one based on a mysterious death mask of a beautiful woman from the late 19th century. The success of Resusci Anne led to the widespread acceptance of CPR and simulation use in medical training.
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Anesthesia and analgesia · Aug 2020
ReviewTechnologies to optimize the care of severe COVID-19 patients for healthcare providers challenged by limited resources.
Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. ⋯ The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.
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Anesthesia and analgesia · Aug 2020
ReviewApplication of Lung Ultrasound during the COVID-19 Pandemic: A Narrative Review.
This review highlights the ultrasound findings reported from a number of studies and case reports and discusses the unifying findings from coronavirus disease (COVID-19) patients and from the avian (H7N9) and H1N1 influenza epidemics. We discuss the potential role for portable point-of-care ultrasound (PPOCUS) as a safe and effective bedside option in the initial evaluation, management, and monitoring of disease progression in patients with confirmed or suspected COVID-19 infection.