Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2012
Multicenter Study Comparative StudyMulticenter study verifying a method of noninvasive continuous cardiac output measurement using pulse wave transit time: a comparison with intermittent bolus thermodilution cardiac output.
Many technologies have been developed for minimally invasive monitoring of cardiac output. Estimated continuous cardiac output (esCCO) measurement using pulse wave transit time is one noninvasive method. Because it does not require any additional sensors other than those for conducting 3 basic forms of monitoring (electrocardiogram, pulse oximeter wave, and noninvasive (or invasive) arterial blood pressure measurement), esCCO measurement is potentially useful in routine clinical circulatory monitoring for any patient including low-risk patients. We evaluated the efficacy of noninvasive esCCO using pulse wave transit time in this multicenter study. ⋯ The efficacy of noninvasive esCCO technology was compared with TDCO in 213 cases. Five hundred eighty-seven datasets comparing esCCO and TDCO showed close correlation and small bias and precision, which were comparable to current arterial waveform analysis technologies.
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Anesthesia and analgesia · Jul 2012
Multicenter StudyA scoring system to predict unplanned intubation in patients having undergone major surgical procedures.
Unplanned tracheal intubation after surgery has been associated with high mortality. Few studies have examined the risk factors for this complication. ⋯ A scoring system based on clinical risk factors was able to accurately predict unplanned intubation after surgery. Further investigation is needed to assess the utility of the Unplanned Intubation Risk Index in reducing the incidence of unplanned intubation through improved risk stratification and management in perioperative care.
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Anesthesia and analgesia · Jun 2012
Randomized Controlled Trial Multicenter StudyMultiple reservoirs contribute to intraoperative bacterial transmission.
Intraoperative stopcock contamination is a frequent event associated with increased patient mortality. In the current study we examined the relative contributions of anesthesia provider hands, the patient, and the patient environment to stopcock contamination. Our secondary aims were to identify risk factors for stopcock contamination and to examine the prior association of stopcock contamination with 30-day postoperative infection and mortality. Additional microbiological analyses were completed to determine the prevalence of bacterial pathogens within intraoperative bacterial reservoirs. Pulsed-field gel electrophoresis was used to assess the contribution of reservoir bacterial pathogens to 30-day postoperative infections. ⋯ Bacterial contamination of patients, provider hands, and the environment contributes to stopcock transmission events, but the surrounding patient environment is the most likely source. Stopcock contamination is associated with increased patient mortality. Patient and provider bacterial reservoirs contribute to 30-day postoperative infections. Multimodal programs designed to target each of these reservoirs in parallel should be studied intensely as a comprehensive approach to reducing intraoperative bacterial transmission.
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Anesthesia and analgesia · Apr 2012
Multicenter StudyIncreases in electroencephalogram and electromyogram variability are associated with an increased incidence of intraoperative somatic response.
sBIS, the variability of the Bispectral Index (BIS), sEMG, the variability of facial electromyogram power (EMG), and the Composite Variability Index (CVI) are 3 new measures of electroencephalogram and EMG variability. CVI is a single measure of the combined variability in BIS and EMG. We investigated whether increases in these variables are associated with intraoperative somatic responses. ⋯ sBIS, sEMG, and CVI, measures of electroencephalogram and EMG variability, increased when intraoperative somatic events occurred. sBIS, sEMG, and CVI discriminated between 10-minute segments that contained a somatic event and those segments that did not contain an event better than changes in HR and mean arterial blood pressure. Furthermore, CVI increases before somatic events began earlier than HR changes and may provide caregivers with an early warning of potentially inadequate antinociception.
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Anesthesia and analgesia · Feb 2012
Randomized Controlled Trial Multicenter Study Comparative StudyThe effects of isoflurane and desflurane on cognitive function in humans.
This small, pilot study suggests that isoflurane may be more commonly associated with post-operative cognitive dysfunction than desflurane in older patients.
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