Journal of clinical anesthesia
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To determine the perioperative mortality and intraoperative morbidity according to operative procedure and postoperative period for American Society of Anesthesiologists' Physical Status (ASA-PS) V category patients. ⋯ The ASA-PS V classification is determined subjectively rather than objectively, and can be variable within its parameters, depending on the individual interpretation of ASA classification, patient population, case severity, surgical and anesthesia factors, and the year of the study. Even though immediate perioperative mortality decreased in our patient population, late postoperative mortality increased during the same time period, possibly demonstrating a shift in mortality time rather than an absolute decrease in overall mortality. Although the ASA-PS V category was never intended to be a predictor of outcome, it correlates with perioperative mortality as well as or even better than other classifications of mortality and morbidity. The decreased mortality in the ASA-PS V patient population may be related to different factors, which are beyond the scope of this study.
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Clinical Trial
Poor prediction of blood transfusion requirements in adult liver transplantations from preoperative variables.
To assess the ability of preoperative information to predict intraoperative blood transfusion requirements in adult orthotopic liver transplantation. ⋯ Preoperative variables are poor predictors of intraoperative transfusion requirements even when significant associations exist, identifying a small proportion of the variability observed. A predictive approach based on this method would be too inaccurate to be of clinical use. The majority of the variability in transfusion requirements during liver transplantation most likely results from intraoperative and donor organ factors.
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Clinical Trial
Maintaining sevoflurane anesthesia during low-flow anesthesia using a single vaporizer setting change after overpressure induction.
A sevoflurane vaporizer dial setting of 1.9% was previously found to maintain the end-expired sevoflurane concentration (Et(sevo)) at 1.3% during maintenance of anesthesia for procedures up to one hour with an O(2) FGF of 1 L/min. We examined whether applying these parameters could simplify low-flow sevoflurane anesthesia after overpressure induction using two slightly different techniques. ⋯ After high-flow overpressure induction with sevoflurane, a single change in vaporizer setting (to 1.9%) and FGF (to 1 L. min(-1)) suffices for the Et(sevo) to approach the predicted Et(sevo) (1.3%) within 10-15 min; thereafter the Et(sevo) remains nearly constant. As expected, the predicted Et(sevo) is attained slightly faster when the vaporizer is temporarily turned off. Clinically applying previously derived pharmacokinetic parameters simplifies low-flow sevoflurane anesthesia after overpressure induction.
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Randomized Controlled Trial Clinical Trial
Rapid induction of anesthesia with high concentrations of halothane or sevoflurane in children.
To compare the characteristics of the rapid induction of anesthesia in pediatric patients with high concentrations of sevoflurane or halothane, and to determine the ability of anesthesiologists to correctly identify the anesthetic drug when administered in this fashion. ⋯ The induction of anesthesia with high concentrations of either halothane or sevoflurane can be safely accomplished. Pediatric anesthesiologists can differentiate between halothane and sevoflurane when either drug is given in high initial concentrations. The presence of tachycardia may have served as the primary clue in determining which drug was being used.