Journal of clinical anesthesia
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Letter Randomized Controlled Trial
Dexamethasone for postadenoidectomy pain reduction. Does it truly work? A prospective randomized double-blind clinical trial.
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Evaluation of faculty anesthesiologists' clinical supervision is psychometrically reliable. Supervision scores often are used for ongoing professional practice and teaching evaluations. We evaluated whether anesthesiologists' clinical supervision rank could be determined reliably using 6- vs. 12-month data collection intervals and, for each, determined specificity (quartiles vs. halves). To serve as a comparator/control group, we analyzed anesthesiologists' evaluations of the work habits of nurse anesthetists. ⋯ Using mixed effects regression to control for rater leniency, anesthesiologists' ranks based on supervision scores can be determined reliably for halves and quartiles, but fewer than half the anesthesiologists will be reliably ranked. The same ranking principles can be applied for evaluation of nurse anesthetists' work habits. Even when very high G-scores of 0.90 are obtained, ranking individuals into smaller groups (e.g., deciles) or using raw (observed) ranks is unreliable.
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The lag in creatinine-mediated diagnosis of cardiac surgery-associated acute kidney injury (AKI) may be impeding the development of renoprotection therapies. Postoperative renal resistive index (RRI) measured by transabdominal Doppler ultrasound is a promising early AKI biomarker. RRI measured intraoperatively by transesophageal echocardiography (TEE) is available even earlier but is less evaluated. Therefore, we conducted an assessment of intraoperative RRI as an AKI biomarker using previously reported post-renal insult thresholds. ⋯ RRI obtained intraoperatively in cardiac surgery patients, assessed using previously reported thresholds, is highly associated with AKI and warrants further evaluation as a promising "earliest" AKI biomarker. These significant findings suggest that RRI assessment should be included in the standard intraoperative TEE exam.
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Randomized Controlled Trial Observational Study
A randomized control trial comparing prophylactic dexmedetomidine versus clonidine on rates and duration of delirium in older adult patients undergoing coronary artery bypass grafting.
Postoperative delirium occurs in 20-50% of elderly patients undergoing cardiac surgery and increases morbidity and mortality. We investigated whether prophylactic dexmedetomidine could reduce delirium incidence in elderly patients after coronary artery bypass grafting (CABG), compared with clonidine. ⋯ Postoperative infusion of dexmedetomidine provides a feasible option for postoperative control of delirium after CABG in adult patients.