Journal of clinical anesthesia
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Randomized Controlled Trial
Multisource feedback in professionalism for anesthesia residents.
To assess professionalism in anesthesiology residents, it is important to obtain evaluations from people with whom they interact on daily basis. The purpose of this study was to evaluate the effect of a Multisource feedback (MSF) on resident's professional behavior and to assess the effect of faculty feedback on resident performance. ⋯ Our new multi-source feedback questionnaire to assess professionalism had good reliability and internal consistency. Using our validated questionnaire we assessed the effect of a monthly feedback to improve professionalism in anesthesia residents. While we did see improvement in anesthesiology residents' self-assessment, we did not see a similar effect on patient family, faculty or coworker evaluations.
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Randomized Controlled Trial
The optimal combination of mechanical ventilator parameters under general anesthesia in obese patients undergoing laparoscopic surgery.
Pulmonary dysfunction after laparoscopic surgery is commonly seen in the high-risk group of obese patients. To reduce or avoid this complication caused by an improper combination of mechanical ventilation parameters, we conducted the following trial of 3 factors with 3 levels of mechanical ventilation, aimed to obtain the low airway pressure with good ventilator effects. ⋯ The best combination of respiratory parameters is A3B1C2, that is, f=9beats per minute, VT=8mL/kg, and I:E=1:2.0. That is, neither small tidal volume and faster frequency nor slow frequency large tidal volume is a good choice. To let obese patients under general anesthesia can obtain a lung protective effect of low airway pressure with good ventilation; it is noteworthy that (1) I:E of airway pressure (PIP, Pmean) is the important impact factor for the protection of the lung and (2) I:E of airway pressure (PIP, Pmean) is the factor with opposite properties.
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Regional anesthesia and analgesia for shoulder surgery is most commonly performed via interscalene nerve block. We developed an ultrasound-guided technique that specifically targets the C5 nerve root proximal to the traditional interscalene block and assessed its efficacy for shoulder analgesia. ⋯ A new technique for ultrasound-guided blockade at the level of the C5 nerve root proximal to the level of the traditional interscalene block is efficacious for shoulder post-operative pain control.
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Randomized Controlled Trial Comparative Study
Comparing the efficacy and safety between propofol and dexmedetomidine for sedation in claustrophobic adults undergoing magnetic resonance imaging (PADAM trial).
To determine the efficacy of sedation with dexmedetomidine compared to propofol for claustrophobic adults undergoing magnetic resonance imaging (MRI) in our institution. ⋯ Both dexmedetomidine and propofol can effectively reduce anxiety levels of claustrophobic adults undergoing MRI, but dexmedetomidine takes longer to achieve adequate anxiolysis and sleep and may have an effect on image quality. Hypotension and bradycardia are common adverse effects observed with dexmedetomidine.
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Randomized Controlled Trial
Dose-ranging effect of systemic diphenhydramine on postoperative quality of recovery after ambulatory laparoscopic surgery: a randomized, placebo-controlled, double-blinded, clinical trial.
Diphenhydramine is an antihistamine with previously demonstrated analgesic and antiemetic properties. However, it is unknown if the beneficial perioperative properties of diphenhydramine can translate to a better quality of postsurgical recovery. The main objective of the current investigation was to investigate dose-ranging effects of diphenhydramine on quality of recovery after surgery. ⋯ Diphenhydramine does not provide dose-ranging improvements on postoperative quality of recovery after ambulatory laparoscopic gynecologic surgery. Our results support a recent concept that not all postoperative nausea and vomiting symptoms are clinically important. Future studies evaluating postoperative nausea and vomiting should include patient-centered outcomes to validate the clinical importance of the examined interventions.