Journal of clinical anesthesia
-
To determine whether our institutional insulin management (modified Atlanta) protocol is efficient and safe in controlling blood glucose levels in the perioperative period in surgical patients undergoing tumor hepatectomy. ⋯ The modified Atlanta protocol is efficient and safe in controlling blood glucose levels in the perioperative period of hepatic tumor resection. Because of decreased insulin needs in the ICU, the use of a more liberal algorithm successfully reduced the risk of hypoglycemia.
-
To evaluate the Warmflo fluid warming system at various flow rates of crystalloid solution simulated to clinical conditions. ⋯ The Warmflo fluid warming system can overheat fluids at temperatures considerably above normal body temperatures.
-
To determine the cost of replacing an anesthesiology resident with a certified registered nurse anesthetist (CRNA) for equal operating room (OR) work. ⋯ A CRNA is paid substantially more per OR hour worked, at all pay levels, than an anesthesiology resident.
-
The Polestar N-20 Scanner (Medtronic Navigation, Louisville, CO) is an intraoperative magnetic resonance image (iMRI) guidance system designed for neurosurgery. Sixty-five patients underwent craniotomy for tumor resection using the iMRI during the period from April 2005 to December 2006. Anesthesiologists used an iMRI-compatible patient monitoring system (Veris MR, MEDRAD, Indianola, PA), anesthesia machine (Aestiva/5 MRI, Datex-Ohmeda, Madison, WI), and infusion pumps (Continuum; MEDRAD). ⋯ None of our iMRI patients underwent a repeat resection, whereas the repeat resection rate for conventional tumor resection is reported to be as high as 30%. The use of a small, low-field iMRI system provided adequate imaging for resection of lesions without the need of repeat resections in the weeks following the initial procedure, and did not significantly alter the anesthetic procedure. A team effort between the anesthesiologists, surgeons, nurses, and MRI technicians is paramount for the practical and efficient use of these iMRI systems.