Operating theatres and anaesthetic rooms are required to be equipped with scavenging systems, but recovery units often are not. We compared exhaled, spectrophotometric sevoflurane and desflurane concentrations 15 cm from the mouth ('patient breathing zone') and 91 cm laterally to the patient ('nurse work zone') in 120 patients after tracheal extubation who were consecutively allocated to either ISO-Gard mask ...
... I focuses on relevant causes for maternal morbidity and mortality as well as preventive measures, pregnancy in obese patients and sepsis in obstetric anaesthesia. Part II addresses established standards and new perspectives in the direct obstetric setting regarding epidural analgesia, post-dural puncture headache, anaesthesia and analgesia during and after caesarean section, haemodynamic monitoring during cesarean section and postpartum haemorrhage.
Anti-Obesity and Weight Loss (1) Post-Dural Puncture Headache (1), Sepsis (1), more mentions
Burnout has a high prevalence among healthcare workers and is increasingly recognised as an environmental problem rather than reflecting a personal inability to cope with work stress. We distributed an electronic survey, which included the Maslach Burnout Inventory Health Services Survey and a previously validated learning environment instrument, to 281 Victorian anaesthetic trainees. The response rate was 50.
... caval venous thrombectomy were reviewed retrospectively during January 2014 to January 2017 in our hospital.Analyzed data includs demographics, classification of tumor, perioperative anesthetic management and monitoring approaches, IVC clamping time , vital signs during cardiopulmonary bypass(CPB), estimated blood loss (EBL), usage of blood products, hospitalization time and ICU time ...
Neoplasms (12), Thrombus (10), Renal Cell Carcinoma (3), more mentions
The aim of this study is to compare monitoredanesthetic care (MAC) and general anesthesia (GA) based on intraoperative vital signs, and the adverse effects after closed reduction of nasal bone fractures.The authors performed a retrospective study of 45 patients who underwent a closed reduction of nasal bone fracture ...
Muscular and Skeletal Diseases (2) Sore Throat (2), more mentions
The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. The safe provision of NORA requires strict adherence to standardized monitoring guidelines including pulse oximetry, capnography, electrocardiogram, and noninvasive blood pressure ampliflier. Body temperature should also be measured in appropriate scenarios. High-risk anesthetics require advanced preparation and monitoring.
AbstractText: To review research highlights of manuscripts published in 2016 that pertain to all aspects of the clinical practice of anesthesiology AbstractText: Narrative review AbstractText: N/A AbstractText: The major themes address broad categories of general anesthesia including airwaymanagement, abdominal surgery, and obstetrical and gynaecological anesthesia. In addition, recent advancements in specialties of anesthesiology including regional anesthesia are reviewed ...
This third installment of the history of basic airwaymanagement discusses the transitional-"progressive"-years of anesthesia from 1904 to 1960... Basic airwaymanagement success was essential for traditional inhalation anesthesia (ether, chloroform) and for the use of the new anesthetic agents (cyclopropane, halothane) and intravenous drugs (thiopental, curare, succinylcholine ...
Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patientsafety and favorable outcomes.
Hundreds of thousands of anesthesia records are created each day. The earliest records were prepared by 2 medical students in late 19th-century Boston. Ernest Codman and Harvey Cushing went on to become prominent surgeons and contributed much to the safety of the surgical patient. Cushing's career is celebrated due to his associations with William Stewart Halsted, Peter Bent Brigham Hospital, Yale University, in New Haven, Connecticut, and his biography of Sir William Osler. Codman is remembered for introducing the morbidity and mortality conference as well as his drive to improve outcomes and patientsafety. We analyze every anesthetic record created by Codman and Cushing and provide both a historical context and perspective on many ways in which their doggedness, brilliance, and insight anticipated many advances that enhanced safety for patients undergoing surgical procedures.
... 0.99±7.69 and 5.67±5.27 for DBP.The oscillometric BP showed poor agreement with intra-arterial BP in cholecyst or bile duct surgeries that may induce gall cardiac reflex under general anesthesia. Therefore, according to the present data, application of oscillometric BP measured by the Philips Intellivue MP50 monitor in these surgery patients under general anesthesia cannot be recommended generally.
The importance of capnometry and end-tidal carbon dioxide (ETCO2) has been underscored in recent years by guidelines as a method to continuously monitor adequacy of ventilation during sedation and anesthesia. Guidelines for cardiopulmonary resuscitation (CPR) recommend attempts to improve CPR quality if ETCO2 is lower than 10 mmHg. ETCO2 is thus a time-critical parameter that may benefit from ...
BACKGROUND: Persistent postoperative pain is a major health problem affecting nearly 30% of all patients undergoing total hip arthroplasty. Previous studies have demonstrated an association between the intensity of acute postoperative pain and persistent pain, but this association might be an epiphenomenon of insufficient intraoperative analgesia. In this study, we investigated the association between the intraoperative level of analgesia and the persistent postoperative pain 6 months after surgery.
METHODS: We investigated 110 patients undergoing primary total hip arthroplasty under total intravenous general anaesthesia in a prospective cohort study. A highly standardized surgical and a standardized anaesthetic procedure were performed to reduce variability and psychosocial influences were investigated to adjust for confounders. Acute postoperative pain was controlled using patient-controlled analgesia pumps. Postoperative pain intensities and analgesic requirements were monitored for 6 months following surgery.
RESULTS: Of 105 patients included in the analysis, 32% continued using daily pain medication 6 months after surgery and reported a median pain level of 4/10. Multivariate analyses confirmed that the amount of intraoperative analgesia is a significant predictor of regular analgesic use and pain intensity 6 months after surgery.
CONCLUSIONS: Higher levels of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption 6 months after total hip arthroplasty. Persistent pain may be attributable to intraoperative nociception, which is likely not adequately assessed and suppressed using current clinical measures.
SIGNIFICANCE: Our study suggests that lower doses of intraoperative analgesia are associated with higher levels of persistent postoperative pain. Persistent pain may be caused by intraoperative nociception, which is likely not adequately suppressed using current clinical standard analgesic measures.
Anesthesia information management systems (AIMS) have evolved from simple, automated intraoperative record keepers in a select few institutions to widely adopted, sophisticated hardware and software solutions that are integrated into a hospital's electronic health record system and used to manage and document a patient's entire perioperative experience. AIMS implementations have resulted in numerous billing, research, and clinical benefits, yet there remain challenges and areas of potential improvement to AIMS utilization. This article provides an overview of the history of AIMS, the components and features of AIMS, and the benefits and challenges associated with implementing and using AIMS. As AIMS continue to proliferate and data are increasingly shared across multi-institutional collaborations, visual analytics and advanced analytics techniques such as machine learning may be applied to AIMS data to reap even more benefits.
PURPOSE: To explore the clinical value of ultrasound-guided superior laryngeal nerve block and cricothyroid membrane puncture in conscious endotracheal intubation.
METHODS: Thirty ASA classⅠorII patients scheduled for selective surgeries were randomly divided into 2 groups, Group U was ultrasound-guided group (n=15), group A was anatomical location group (n=15). Transnasal tracheal intubation was performed in all patients. In patient of group U, thyrohyoid membrane was shown hyperecho by ultrasound and echoless superior laryngeal artery passed across it. Then local anesthetic was injected into inner side of the artery by ultrasound-guided in-plane technology. The same process was conducted in the contralateral side. The cricothyroid membrane was shown as strong echo by ultrasound and the needle was inserted across the membrane by ultrasound-guided in-plane technology. Local anesthetic was injected for surface anesthesia. In patients of group A, superior horn of thyroid cartilage and horn of hyoid cartilage were identified by palpation of the anatomical structure. Traditional bilateral superior laryngeal nerve block was then performed. Thyroid cartilage and cricoid cartilage were marked by palpation of the anatomical structure and local anesthetic was then injected through cricothyroid membrane puncture for tracheal surface anesthesia. All patients experienced rapid anesthesia induction after confirmation of the tracheal intubation. The success rate of cricothyroid membrane puncture, rate of bucking and hemodynamic change around the time of tracheal intubation of each group were recorded. SPSS 20.0 software package was applied for statistical analysis.
RESULTS: Compared with group A, the success rate of cricothyroid membrane puncture in group U was significantly higher (P<0.05) and the rate of bucking was significantly lower (P<0.05).Compared with group A, HR, SBP and DBP in group U at T1,T2 and T5 had no significant difference (P>0.05), but the amount of increase was significantly smaller at T3 and T4 (P<0.05).
CONCLUSIONS: Ultrasound-guided superior laryngeal nerve block and cricothyroid membrane puncture in conscious endotracheal intubation is a safe and effective way with more advantages.
Monitoredanesthesia care was provided with midazolam and remifentanil AbstractText: Total amounts of remifentanil infused were similar between the groups (626±251 μg vs. 597±315 μg, P = 0.606. Accounting for the mean duration of the procedure and the elimination half-life of propacetamol, remifentanil requirements were significantly less among patients whose procedure ended within 180 min (n = 56) in ...
Although regional anesthesia for ambulatory patients is feasible, effective and recommended, general anesthesia, analgosedation and monitoredanesthesia care traditionally play a major role in the ambulatory setting. This discrepancy is at least partially caused by a more standardized and predictable process when using general anesthesia. High patient comfort, a low rate of complications and a rapid postoperative recovery are expected ...
Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airwaymanagement are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures.
In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non-operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome.