... for grading the quality of evidence; and to identify review characteristics associated with conclusiveness AbstractText: Cross-sectional analysis of Cochrane systematic reviews from the Anaesthesia, CriticalCare and Emergency Review Group was undertaken AbstractText: The Cochrane webpage was used to identify reviews for inclusion (http://.ace.cochrane.org/) AbstractText: New and ...
... the implementation 10 years ago of a registry for safety in regional anesthesia and acute pain therapy by the German Society of Anesthesiology and IntensiveCare Medicine (DGAI) and the Association of German Anesthesiologists (BDA), it has been possible to answer important safety questions and define protective measures (e.g ...
Infectious Diseases (1), Anti-Obesity and Weight Loss (1) Acute Pain (1), more mentions
... AbstractText: A total of 434 amputations in 323 patients were included in the study. The number of surgical complications, the need for surgical revision and the number of intensivecare unit admissions were significantly higher in the general anaesthesia group. The need for post-operative opioid medication was significantly lower in patients with above-the-knee amputation and spinal anaesthesia.
INTRODUCTION: Unintentional catecholamine flush caused by inappropriate release of an intravenous occlusion during use of a syringe pump in the intensive care unit (ICU) can have dangerous consequences in patients receiving criticalcare. We investigated whether anesthesiology residents understood how to deal with syringe pump occlusion in a simulated ICU setting.
METHODS: We set up a mannequin that virtually simulated a sedated patient under mechanical ventilation after cardiac surgery, with epinephrine and dopamine being infused by syringe pumps to maintain blood pressure at 100/50 mm Hg. Prior to a participant entering the simulated ICU, one of the stopcocks for the catecholamine was occluded. Thereafter, the blood pressure of the mannequin dropped to 60/30 mm Hg. If the participant inappropriately released the occlusion, resulting in a catecholamine flush, an operator immediately elevated the blood pressure to 200/100 mm Hg. In the subsequent debriefing session, the simulation facilitator evaluated whether the participant could diagnose that intravenous occlusion was the cause of hypotension in this scenario.
RESULTS: Sixteen anesthesiology residents participated in the study. Only 3 of 10 participants who had previous knowledge of how such situations should be handled could appropriately release back pressure. Eleven residents released the occlusion without relieving syringe pressure. After their debriefing sessions, all the participants were of the opinion that the present simulation training was impressive and useful for them.
CONCLUSIONS: Anesthesiology residents might inappropriately handle a situation of intravenous occlusion in their clinical practice. It may be necessary for the manufacturers to improve the safety features of syringe pumps.
Therefore, the German Scientific Societies of Anesthesiology and IntensiveCare Medicine (DGAI), Internal Medicine (DGIM), and Surgery (DGCH) have joined to elaborate recommendations on the preoperative evaluation of adult patients prior to elective noncardiothoracic surgery which were initially published in 2010. These recommendations have now been updated based on the current literature and existing international guidelines.
Cardiovascular Diseases (1) Cardiovascular Diseases (1), more mentions
... in intensive care unit.A total of 126 patients who needed mechanical ventilation were recruited.With a method of before and after paired comparison, they were divided into two group: (1) analgesia with empirical administration or control group; (2) goal directed analgesia based on critical-care pain observation tool (CPOT.
Dexmedetomidine-associated hyperthermia has not been previously studied. Analysis is warranted to determine whether this potentially dangerous complication is more prevalent than previously realised. We aimed to examine the association between dexmedetomidine and temperature ≥39.5°C, including patient characteristics, temporality and potential risk factors. We conducted a retrospective cohort study of all intensive care unit (ICU) admissions between 1 July 2009 and 31 May 2016 in a tertiary ICU in Australia. Temperature data was available for 9,782 ICU admissions. Dexmedetomidine was given intravenously to 611 (6.3%) patients at a dose of 0 to 1.5 g/kg/hour. Temperatures ≥39.5°C were recorded in 341 (3.5%) patients. Overall hospital mortality was 10.8% for all admissions and 29.3% for patients with temperatures ≥39.5°C. Dexmedetomidine exposure was more frequent in patients with temperature recordings ≥39.5°C compared to those with temperatures <39.5°C, 11.94% versus 2.94% (odds ratio [OR] 4.49; 95% confidence intervals [CI] 3.37, 5.92; <i>P</i> <0.001). The association was stronger for patients post-open heart surgery (OHS) with temperatures ≥39.5°C (OR 12.9; 95% CI 5.01, 31.62; <i>P</i> <0.001). Multivariate analysis showed an independent association between dexmedetomidine and a temperature ≥39.5°C in two particular patient groups: OHS (OR 2.72; 95% CI 1.1, 6.9; <i>P</i> <0.001), and obesity (OR 3.44; 95% CI 1.5, 7.9; <i>P</i> <0.001). Dexmedetomidine exposure is associated with an increased risk of hyperthermia. Possible risk factors are open heart surgery and obesity.
Background: Behavioural pain tools are used in Intensive Care Unit (ICU) patients unable to self-report their pain-intensity but need sustained efforts to educate and train the ICU team because of the subjective nature of these clinical tools. This study measured the validity and performance of an electrophysiological monitoring tool based on the spectral analysis of heart rate variability, the Analgesia Nociception Index (ANI) which varies from 0 (minimal parasympathetic tone, maximal stress-response and pain) to 100 (maximal parasympathetic tone, minimal stress-response and pain).
Methods: Mean-ANI (ANIm) and Instant-ANI (ANIi) were continuously recorded then compared with the Behavioral Pain Scale (BPS) before, during and after routine care procedures in critically-ill non-comatose patients.
Results: 969 assessments were performed in 110 patients. ANIi was the most discriminative pain tool. It was significantly correlated with BPS (r=-0.30; 95%CI -0.37 to -0.25; P<0.001). For an ANIi threshold of 42.5, the sensitivity, specificity, positive and negative predictive values were respectively 61.4%, 77.4%, 37.0%, and 90.4%. Compared with the BPS, ANIi had no significantly different ability to change during turning and tracheal-suctioning but changed significantly more during dressing change. ANIi increased independently with age, obesity and severity of illness, and controlled mechanical-ventilation, vasopressors use and analgesia. ANIi decreased independently when vigilance status and respiratory rate increased. ANIm demonstrated poor psychometric properties to detect pain.
Conclusions: Despite low sensitivity/specificity, ANIi≥43 had a Negative-Predictive-Value of 90%. Hence ANIi may be of highest benefit for excluding significant pain. A randomized controlled trial should compare sedation-analgesia protocols based on ANIi to presently recommended behavioural-pain-tools.
Anti-Obesity and Weight Loss (1) Obesity (1), Delirium (1), Coma (1), more mentions
Ascertaining which patients are at highest risk of poor postoperative outcomes could improve care and enhance safety. This study aimed to construct and validate a propensity index for 30-day postoperative mortality. A retrospective cohort study was conducted at Hospital de Clínicas de Porto Alegre, Brazil, over a period of 3 years. A dataset of 13524 patients was used to develop the model and another dataset of 7254 was used to validate it. The primary outcome was 30-day in-hospital mortality. Overall mortality in the development dataset was 2.31% [n = 311; 95% confidence interval: 2.06-2.56%]. Four variables were significantly associated with outcome: age, ASA class, nature of surgery (urgent/emergency vs elective), and surgical severity (major/intermediate/minor). The index with this set of variables to predict mortality in the validation sample (n = 7253) gave an AUROC = 0.9137, 85.2% sensitivity, and 81.7% specificity. This sensitivity cut-off yielded four classes of death probability: class I, <2%; class II, 2-5%; class III, 5-10%; class IV, >10%. Model application showed that, amongst patients in risk class IV, the odds of death were approximately fivefold higher (odds ratio 5.43, 95% confidence interval: 2.82-10.46) in those admitted to intensive care after a period on the regular ward than in those sent to the intensivecare unit directly after surgery. The SAMPE (Anaesthesia and Perioperative Medicine Service) model accurately predicted 30-day postoperative mortality. This model allows identification of high-risk patients and could be used as a practical tool for care stratification and rational postoperative allocation of critical care resources.
... metabolic stresses in the donor, rendering the majority of offered organs unsuitable for transplantation. Coupled with our inability to acquire exact molecular and cellular information and missed opportunities for effectively modulating deteriorations of donors and allografts, anesthesia and criticalcare contributes to ongoing organ shortages. Progress is made with improving waiting lists by bridging patients for transplantation using mechanical support.
... used and summarised the effects of different combinations of interventions on practices AbstractText: Forty-six studies met the inclusion criteria and covered the specialty groups of obstetrics and gynaecology (n=9), paediatrics and neonatology (n=4), intensivecare (n=4), internal medicine (n=20), and anaesthetics and surgery (n=3.
Draft guidelines for the study of medications for treatment of drug addiction have been developed by the Food and Drug Administration's (FDA's) Center for Drug Evaluation and Research, Division of Anesthetic, CriticalCare and Addiction Drug Products. These guidelines are intended to provide a common basis for planning, evaluating and interpreting clinical studies and facilitating development of new and effective ...
Heroin Dependence (1), Drug Dependence (1), Cocaine Dependence (1), more mentions
... was essential to developing the surgical management of patients with head and neck cancer. Since that time, advents in anesthesia, intensivecare, and improved diagnostic abilities have improved our ability to surgically manage and treat head and neck cancer. The original paradigm of resection, reconstruction, and rehabilitation was formulated as we endeavored to develop paradigms of treatment for our patients.
On average, 10 to 13 physicians every year - that is, one per month - are punished. Those most often punished are obstetrician-gynaecologists (13%), followed by intensivecareanaesthetists (11%) and then by general practitioners (6.7. The offences most frequently occurring are manslaughter (36.5%), illegal profits (12%), unintentional injuries (11.5%) and sexual offences (10.1.
Seventy-two percent of evacuations were individual, and 28% were performed in groups. The air medical team was enhanced by a criticalcareanesthesiologist in 85% of the cases. No deaths occurred in-flight.The French experience in Afghanistan was marked by performing mostly individual STRAT AEs among wounded warriors requiring extensive medicalization.