Journal of clinical anesthesia
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We present a case of profound shock and lactic acidemia occurring in the context of a cryoablative procedure for hepatocellular carcinoma. After out ruling more common possible etiologies, we diagnosed our patient as having a rare cause of shock, unique to these types of cryoablative procedures, known as cryoshock. Cryoablation can result in multiple complications one of which is 'cryoshock', a life-threatening syndrome of multiorgan failure and coagulopathy that carries a high mortality, up to 40%. ⋯ Reports of the management of cryoshock are scarce and the mainstay of treatment is organ support. While cryoshock has been described in radiology and surgical literature it has not previously been described in anesthesiology literature. We highlight this as a potential serious complication which should be considered by all clinicians involved in these cases.
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Randomized Controlled Trial
Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures; a post-implementation prospective case-cohort study.
A randomized controlled study demonstrated that an optimized intraoperative infection control program targeting basic preventive measures can reduce Staphylococcus aureus transmission and surgical site infections. In this study we address potential limitations of operating room heterogeneity of infections and compliance with behavioral interventions following adoption into clinical practice. ⋯ An optimized intraoperative infection control program targeting improvements in basic preventive measures is an effective and feasible approach for reducing S. aureus transmission and surgical site infection development.
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Observational Study
Education based on publicly-available keyword data is associated with decreased stress and improved trajectory of in-training exam performance.
This study aimed to assess the impact of data-driven didactic sessions on metrics including fund of knowledge, resident confidence in clinical topics, and stress in addition to American Board of Anesthesiology In-Training Examination (ITE) percentiles. ⋯ Data-driven didactics was associated with improved resident confidence, stress, and factors related to wellness. It was also associated with a change from a negative to positive trend in ITE percentiles over time. Future assessment of data-driven didactics and impact on resident outcomes are needed.
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To describe the anesthetic management and outcomes of placenta accreta spectrum (PAS) cases at our institution over a 19 year period and to compare outcomes associated with the lumbar combined spinal epidural (CSE) technique versus the double catheter technique (lumbar CSE with thoracic epidural catheter). ⋯ Neuraxial anesthesia is the most commonly used technique for PAS cases in our practice. The double catheter technique was associated with lower GA conversion rates compared to the CSE technique in our cohort.
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To evaluate the impact of high flow nasal oxygenation (HFNO) on the risk of hypoxemia during gastrointestinal endoscopic procedures (GEPs) under sedation. ⋯ Our results demonstrated the efficacy of high flow nasal oxygenation for reducing the risk of hypoxemia in patients receiving elective gastrointestinal endoscopic procedures under sedation. Further studies are warranted to verify its cost-effectiveness in the gastrointestinal endoscopy setting.