Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2021
Observational StudyPreoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study.
Postoperative pain management is key for patient satisfaction. Pressure pain threshold (PPT) has been studied in some surgical cohorts but has not been studied in relationship to acute postoperative pain in short-stay patients undergoing anorectal surgery. We hypothesized that preoperative finger PPT measurements can identify respective patients with higher postoperative pain. Aiming to understand the relationship with subjective postoperative pain perception, we tested the hypotheses that preoperative PPT is associated with postoperative Visual Analog Scale (VAS) pain scores and correlates with postoperative analgesic consumption in short-stay patients undergoing anorectal surgery. ⋯ Preoperative finger PPT is associated with postoperative pain and might help identify patients who are at risk of developing more severe postoperative pain on anorectal surgery. Especially in ambulatory and short-stay settings, this approach can help to address patients' high variability in pain sensitivity to facilitate appropriate postoperative analgesia, timely discharge, and prevent readmission.
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Anesthesia and analgesia · Mar 2021
Historical ArticleThe Origins, Evolution, and Spread of Anesthesia Monitoring Standards: From Boston to Across the World.
In the mid-1980s, the anesthesia departments at hospitals affiliated with Harvard Medical School were faced with a challenge: mounting medical malpractice costs. Malpractice insurance was provided by the Controlled Risk Insurance Company (CRICO), a patient safety and medical malpractice insurance company owned by and providing service to the Harvard medical community. CRICO spearheaded an effort to reduce these costs and ultimately found a way to decrease the risks associated with anesthesia. ⋯ What began as an attempt to lower medical malpractice costs in a group of university hospitals became a worldwide effort that resulted in improvements in patient safety. Other specialties have adopted similar measures. Currently, an attitude and appreciation of safety are exemplified by several practices that include among others-the adherence to these patient safety guidelines, simulator training, the promulgation of standards and guidelines by ASA, and the use of a safety checklist before induction of anesthesia.
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Anesthesia and analgesia · Mar 2021
Clinical TrialElevated Plasma Concentrations of Syndecan-1 Do Not Correlate With Increased Capillary Leakage of 20% Albumin.
Preclinical experiments show that an inflammatory reaction causes degradation of the endothelial glycocalyx layer and accelerated capillary leakage of albumin and fluid. The hypothesis in the present study was that elevated plasma concentrations of glycocalyx degradation products are associated with greater capillary leakage in humans. ⋯ A raised plasma concentration of syndecan-1 alone cannot be extrapolated to indicate increased capillary leakage of albumin and fluid.
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Anesthesia and analgesia · Mar 2021
Comparative Study Observational StudyDo It Often, Do It Better: Association Between Pairs of Experienced Subspecialty Anesthesia Caregivers and Postoperative Outcomes. A Retrospective Observational Study.
Anesthesiologists typically care for patients having a broad range of procedures. Outcomes might be improved when care is provided by caregivers experienced in particular types of surgery. We tested the hypothesis that intraoperative care provided by pairs of anesthesia caregivers having significant experience with a particular type of surgery reduces a composite of in-hospital death and 6 serious complications, including bleeding, cardiac, gastrointestinal, infectious, respiratory, and urinary complications, compared to care provided by pairs of anesthesia caregivers with less experience. ⋯ Anesthesia care by experienced pairs was associated with fewer bleeding complications, fewer infections, shorter hospitalization, and reduced in-hospital mortality.
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Anesthesia and analgesia · Mar 2021
Educating Anesthesiologists During the COVID-19 Pandemic and Beyond.
The coronavirus disease 2019 (COVID-19) pandemic has altered approaches to anesthesiology education by shifting educational paradigms. This vision article discusses pre-COVID-19 educational methodologies and best evidence, adaptations required under COVID-19, and evidence for these modifications, and suggests future directions for anesthesiology education. Learning management systems provide structure to online learning. ⋯ Acquiring learning management systems and holding more frequent simulation and skills sessions with fewer learners may increase cost. With the increasing dependency on multimedia and technology support for teaching and learning, one important focus of educational research is on the development and evaluation of strategies that reduce extraneous processing and manage essential and generative processing in virtual learning environments. Collaboration to identify and implement best practices has the potential to improve education for all learners.