Best practice & research. Clinical anaesthesiology
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Increased attention in recent years in both the academic literature and general media on awareness during general anaesthesia has raised the spectre of an increase in the liability burden of anaesthesia awareness. Liability will be different around the world, largely influenced by factors such as the presence of no-fault compensation systems for medical complications in some countries and the characteristics of the common law tort systems in others, such as the United States. A review of the largest single source for liability data, the American Society of Anesthesiologists' Closed Claims database, found the proportion of anaesthesia malpractice claims and claim payment amounts for awareness did not increase during the 1990s. However, due to the time lag to settlement of claims, this data predates recent attention to awareness and electroencephalographic monitoring, factors that may increase liability for awareness in the future.
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Best Pract Res Clin Anaesthesiol · Sep 2007
Awareness, dreaming and unconscious memory formation during anaesthesia in children.
Recent studies have reported an incidence of awareness in children of around 1%, while older studies reported incidences varying from 0% to 5%. Measuring awareness in children requires techniques specifically adapted to a child's cognitive development and variations in incidence may be partly explained by the measures used. The causes and consequences of awareness in children remain poorly defined, though a consistent finding is that many children do not seem distressed by their memories. ⋯ Compared to explicit memory, implicit memory is more robust in young children; however there is no evidence yet for implicit memory formation during anaesthesia in children. Children less than 3 years of age do not form explicit memory, although toddlers, infants and even neonates have signs of consciousness and implicit memory formation. In these very young children the relevance of awareness remains largely unknown.
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Best Pract Res Clin Anaesthesiol · Sep 2007
Incidence of and risk factors for awareness during anaesthesia.
Explicit recall of events during general anaesthesia is detected by direct questioning, as patients may not report awareness spontaneously or if they are questioned non-specifically. More than one interview is needed and credibility of reports should always be verified. ⋯ Studies of patients recruited through referrals by colleagues or advertisements, studies of compensation claims and those carried out through quality improvement systems are inadequate. Several factors increase the risk of awareness, including light anaesthesia, some types of surgery, a history of awareness, chronic use of central nervous system depressants, younger age, obesity, inadequate or misused anaesthesia delivery systems, insufficient knowledge about awareness, and ignoring the use of electroencephalographic monitors when the risk is otherwise increased.
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Best Pract Res Clin Anaesthesiol · Jun 2007
The impact of storage on red cell function in blood transfusion.
Despite the common use of red-blood-cell transfusions in clinical practice, actual beneficial effects of red blood cells have never been demonstrated. On the contrary, several studies suggest that red-blood-cell transfusions are associated with higher risks of morbidity and mortality. The effects of the duration of storage on the efficacy of red blood cells have therefore been questioned in a number of studies. Recent insights into the physiology of red blood cells such as the role of the hypoxia-induced vasodilator-releasing function of red blood cells--is discussed in relation to the controversy surrounding the use of blood transfusions in clinical practice.
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Best Pract Res Clin Anaesthesiol · Jun 2007
ReviewEstimating the cost of blood: past, present, and future directions.
Understanding the costs associated with blood products requires sophisticated knowledge about transfusion medicine and is attracting the attention of clinical and administrative healthcare sectors worldwide. To improve outcomes, blood usage must be optimized and expenditures controlled so that resources may be channeled toward other diagnostic, therapeutic, and technological initiatives. Estimating blood costs, however, is a complex undertaking, surpassing simple supply versus demand economics. ⋯ Recognizing that historical accounting attempts to determine blood costs have varied in scope, perspective, and methodology, new approaches have been initiated to identify all potential cost elements related to blood and blood product administration. Activities are also under way to tie these elements together in a comprehensive and practical model that will be applicable to all single-donor blood products without regard to practice type (e.g., academic, private, multi- or single-center clinic). These initiatives, their rationale, importance, and future directions are described.