The Ochsner journal
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The Ochsner journal · Jan 2011
Initial experience with implanted peripheral nerve stimulation for the treatment of refractory cephalgia.
To report 4 cases of improved pain control and function in patients with chronic cephalgia secondary to chronic headaches and/or trigeminal neuralgia. ⋯ Initial experience suggests that refractory pain secondary to chronic migraines and trigeminal neuralgia may respond to peripheral nerve stimulation. Further studies are indicated to evaluate efficacy over the long term and to elucidate the optimal array and implantation technique.
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α(2)-Agonists are a novel class of drugs with mechanisms of action that differ from other commonly used anesthetic drugs. They have neuroprotective, cardioprotective, and sedative effects. These unique characteristics make them potentially useful during neuroanesthesia and intensive care. We review the effects of dexmedetomidine on cerebral blood flow and cerebral metabolism, along with recent advances in using α(2)-agonists in neuroanesthesia and neurointensive care.
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The Ochsner journal · Jan 2011
Epidural Anesthesia for Cesarean Delivery in a Patient With Severe Pulmonary Artery Hypertension and a Right-to-Left Shunt.
A 38-year-old woman with severe pulmonary artery hypertension and a right-to-left shunt of unknown etiology presented at 32 weeks' gestational age. Determination of the cause of her pulmonary hypertension by transesophageal echocardiography was delayed until after delivery secondary to anesthetic risk. ⋯ Transesophageal echocardiography after delivery revealed a patent foramen ovale, indicating a diagnosis of idiopathic pulmonary artery hypertension and a very poor prognosis. Differentiating between Eisenmenger syndrome and idiopathic pulmonary artery hypertension may not be important for determining the optimal anesthetic management of patients with pulmonary hypertension but is important in assessing long-term prognosis.
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Several authors have told the John Adriani story, but his proper recognition in developing the specialty of anesthesiology and his place as a pioneer have never been presented as such. The following article outlines his training and experiences in the early days of anesthesiology. The story of the many problems he encountered and how he developed teaching programs that remain in existence today is one to be admired and appreciated. ⋯ During his tenure as the Director of Anesthesia at Charity Hospital, I was a surgical house officer in the early 1960s and returned as an anesthesiology trainee in the late 1970s. We became close personal friends. He gave me hundreds of his slides, and we had many discussions about the past and current state of the specialty of anesthesiology.
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The Ochsner journal · Jan 2011
Implementation of an Anesthesia Information Management System (AIMS).
During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care-related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. ⋯ Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges.