Τρίτη 20 Αυγούστου 2019


Preoperative Erythropoietin in Cardiac Surgery: Evolving Standard of Care or Aggregation of Marginal Gain?
No abstract available
Anesthesia & Analgesia - Current Issue
3m
Shiver Me Timbers: Magnesium and Postoperative Shivering
No abstract available
Anesthesia & Analgesia - Current Issue
3m
Families in the Intensive Care Unit: A Guide to Understanding, Engaging, and Supporting at the Bedside
No abstract available
Anesthesia & Analgesia - Current Issue
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Correct Baseline Comparisons in a Randomized Trial
No abstract available
Anesthesia & Analgesia - Current Issue
3m
Persistent Nociception Facilitates the Extinction of Morphine-Induced Conditioned Place Preference
BACKGROUND: As opioid abuse and addiction have developed into a major national health crisis, prescription of opioids for pain management has become more controversial. However, opioids do help some patients by providing pain relief and improving the quality of life. To better understand the addictive properties of opioids under chronic pain conditions, we used a conditioned place preference (CPP) paradigm to examine the rewarding properties of morphine in rats with persistent nociception. METHODS:...
Anesthesia & Analgesia - Current Issue
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Remote Monitoring in the Perioperative Setting: Calling for Research and Innovation Ecosystem Development
No abstract available
Anesthesia & Analgesia - Current Issue
3m
Adductor Canal Block: A Synthesis of the Evidence?
No abstract available
Anesthesia & Analgesia - Current Issue
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Intraoperative Transfusion Targets: Avoiding the Extremes
No abstract available
Anesthesia & Analgesia - Current Issue
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Bilateral Thoracic Paravertebral Blocks Compared to Thoracic Epidural Analgesia After Midline Laparotomy: A Pragmatic Noninferiority Clinical Trial
BACKGROUND: Bilateral paravertebral block (PVB) is a suitable alternative to thoracic epidural analgesia (TEA) for abdominal surgeries. This randomized clinical trial aims to determine if PVB is noninferior to TEA in terms of analgesia after midline laparotomy. METHODS: Seventy American Society of Anesthesiologists (ASA) class I–III patients undergoing a laparotomy through a midline incision were randomized to receive either TEA (TEA group) or continuous bilateral PVB (PVB group) as a part...
Anesthesia & Analgesia - Current Issue
3m
Walking the Tightrope of Bleeding Control: Fibrinolysis in Trauma
No abstract available
Anesthesia & Analgesia - Current Issue
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Transfusion Management of the Obstetrical Patient: A Clinical Casebook
No abstract available
Anesthesia & Analgesia - Current Issue
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Retrograde Type B Aortic Dissection Caused by Intraaortic Balloon Counterpulsation
No abstract available
Anesthesia & Analgesia - Current Issue
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In Response
No abstract available
Anesthesia & Analgesia - Current Issue
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A Bullet in the Aortic Root: Utility of Transesophageal Echocardiography in Penetrating Thoracic Trauma
No abstract available
Anesthesia & Analgesia - Current Issue
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Heads Up: Our Definition of “Normal” Matters
No abstract available
Anesthesia & Analgesia - Current Issue
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Grade 3 Echocardiographic Diastolic Dysfunction Is Associated With Increased Risk of Major Adverse Cardiovascular Events After Surgery: A Retrospective Cohort Study
BACKGROUND: Diastolic dysfunction is common and may increase the risk of cardiovascular complications. This study investigated the hypothesis that, in patients with isolated left ventricular diastolic dysfunction, higher grade diastolic dysfunction was associated with greater risk of major adverse cardiovascular events (MACEs) after surgery. METHODS: This was a retrospective cohort study. Data of adult patients with isolated echocardiographic diastolic dysfunction (ejection fraction, ≥50%)...
Anesthesia & Analgesia - Current Issue
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The Next Frontier of Clinical Monitoring: Current and Future Directions of Remote Surveillance Technology
No abstract available
Anesthesia & Analgesia - Current Issue
3m
Coagulation Factor Levels and Underlying Thrombin Generation Patterns in Adult Extracorporeal Membrane Oxygenation Patients
BACKGROUND: There is a paucity of data on the underlying procoagulant–anticoagulant balance during extracorporeal membrane oxygenation (ECMO). We hypothesized that adult ECMO patients would have an imbalance between procoagulant and anticoagulant factors, leading to an abnormal underlying thrombin generation (TG) pattern. METHODS: Twenty adult venoarterial (VA) ECMO patients had procoagulant and anticoagulant factor levels measured temporally on ECMO day 1 or 2, day 3, and day 5. In heparin-neutralized...
Anesthesia & Analgesia - Current Issue
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Weeding Out the Problem: The Impact of Preoperative Cannabinoid Use on Pain in the Perioperative Period
BACKGROUND: The recreational and medical use of cannabinoids has been increasing. While most studies and reviews have focused on the role of cannabinoids in the management of acute pain, no study has examined the postoperative outcomes of surgical candidates who are on cannabinoids preoperatively. This retrospective cohort study examined the impact of preoperative cannabinoid use on postoperative pain scores and pain-related outcomes in patients undergoing major orthopedic surgery. METHODS:...
Anesthesia & Analgesia - Current Issue
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Feasibility of a Perioperative Text Messaging Smoking Cessation Program for Surgical Patients
Although surgical patients who smoke could benefit from perioperative abstinence, few currently receive support. This pilot study determined the feasibility and acceptability of a perioperative text messaging smoking cessation program. One hundred patients (73% of eligible patients approached) enrolled in a surgery-specific messaging service, receiving 1–3 daily messages about smoking and surgical recovery for 30 days. Only 17 patients unenrolled, the majority responded to prompting messages, and...
Anesthesia & Analgesia - Current Issue
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Road to Perioperative Medicine: A Perspective From China
With the development of anesthesiology, patient safety has been remarkably improved, but the postoperative mortality rate at 30 days is still as high as 0.56%–4%, and the morbidity is even higher. Three years ago, the Chinese Society of Anesthesiology proposed that the direction of the anesthesiology development should be changed to perioperative medicine in China. Anesthesiologists should pay more attention to the long-term outcome. In this article, we introduced what we have done, what the challenges...
Anesthesia & Analgesia - Current Issue
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Transport of Critically Ill Patients by the Anesthesia Versus the Intensive Care Unit Service: A Before–After Study of Operating Room Workflows
BACKGROUND: We implemented a new policy at our institution where the responsibility for intensive care unit (ICU) patient transports to the operating room (OR) was changed from the anesthesia to the ICU service. We hypothesized that this approach would be associated with increased on-time starts and decreased turnover times. METHODS: In the historical model, intubated patients or those on mechanical circulatory assistance (MCA) were transported by the anesthesia service to the OR (“pre-ICU...
Anesthesia & Analgesia - Current Issue
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Functional MRI: Basic Principles and Emerging Clinical Applications for Anesthesiology and the Neurological Sciences
No abstract available
Anesthesia & Analgesia - Current Issue
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Invasive Respiratory or Vasopressor Support and/or Death as a Proposed Composite Outcome Measure for Perioperative Care Research
BACKGROUND: There is a need for a clinically relevant and feasible outcome measure to facilitate clinical studies in perioperative care medicine. This large-scale retrospective cohort study proposed a novel composite outcome measure comprising invasive respiratory or vasopressor support (IRVS) and death. We described the prevalence of IRVS in patients undergoing major abdominal surgery and assessed the validity of combining IRVS and death to form a composite outcome measure. METHODS: We retrospectively...
Anesthesia & Analgesia - Current Issue
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Hensley’s Practical Approach to Cardiothoracic Anesthesia, 6th ed
No abstract available
Anesthesia & Analgesia - Current Issue
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Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis
BACKGROUND: Clinical trials regarding the antishivering effect of perioperative magnesium have produced inconsistent results. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of perioperative magnesium on prevention of shivering. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and 2 registry sites for randomized clinical trials that compared the administration of magnesium to a placebo...
Anesthesia & Analgesia - Current Issue
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Population Pharmacokinetics of Periarticular Ketorolac in Adult Patients Undergoing Total Hip or Total Knee Replacement Surgery
BACKGROUND: Ketorolac tromethamine has been used for joint infiltration by the orthopedic surgeons as a part of postoperative multimodal analgesia. The objective of this study is to investigate the pharmacokinetic properties of S (−) and R (+) enantiomers of ketorolac in adult patients undergoing total hip (THA) and knee arthroplasty (TKA). METHODS: Adult patients with normal preoperative renal function received a periarticular infiltration of 30 mg of ketorolac tromethamine along with 100...
Anesthesia & Analgesia - Current Issue
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Obstructive Sleep Apnea and Perioperative Outcomes: We Should Not Confuse the Probability With the Established Diagnosis
No abstract available
Anesthesia & Analgesia - Current Issue
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Prolonged Duration Local Anesthesia by Combined Delivery of Capsaicin- and Tetrodotoxin-Loaded Liposomes
BACKGROUND: Capsaicin, the active component of chili peppers, can produce sensory-selective peripheral nerve blockade. Coadministration of capsaicin and tetrodotoxin, a site-1 sodium channel blocker, can achieve a synergistic effect on duration of nerve blocks. However, capsaicin can be neurotoxic, and tetrodotoxin can cause systemic toxicity. We evaluated whether codelivery of capsaicin and tetrodotoxin liposomes can achieve prolonged local anesthesia without local or systemic toxicity. METHODS:...
Anesthesia & Analgesia - Current Issue
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Increasing the Scope on Difficult Airways: What About Mask Ventilation?
No abstract available
Anesthesia & Analgesia - Current Issue
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Device-Related Error in Patient-Controlled Analgesia: Analysis of 82,698 Patients in a Tertiary Hospital
BACKGROUND: Patient-controlled analgesia (PCA) is one of the most popular and effective methods for managing postoperative pain. Various types of continuous infusion pumps are available for the safe and accurate administration of analgesic drugs. Here we report the causes and clinical outcomes of device-related errors in PCA. METHODS: Clinical records from January 1, 2011 to December 31, 2014 were collected by acute pain service team nurses in a 2715-bed tertiary hospital. Devices for all...
Anesthesia & Analgesia - Current Issue
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Comments Regarding Recommendations by the Perioperative Neurotoxicity Working Group
No abstract available
Anesthesia & Analgesia - Current Issue
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Profound Intraoperative Hypotension Associated With Transfusion via the Belmont Fluid Management System
This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated....
Anesthesia & Analgesia - Current Issue
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Do You Really Mean It? Assessing the Strength, Frequency, and Reliability of Applicant Commitment Statements During the Anesthesiology Residency Match
BACKGROUND: Despite the critical nature of the residency interview process, few metrics have been shown to adequately predict applicant success in matching to a given program. While evaluating and ranking potential candidates, bias can occur when applicants make commitment statements to a program. Survey data show that pressure to demonstrate commitment leads applicants to express commitment to multiple institutions including telling >1 program that they will rank them #1. The primary purpose...
Anesthesia & Analgesia - Current Issue
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Remote Surveillance Technologies: Realizing the Aim of Right Patient, Right Data, Right Time
The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into...
Anesthesia & Analgesia - Current Issue
4m
Usefulness of the Korean Version of the CAGE-Adapted to Include Drugs Combined With Clinical Predictors to Screen for Opioid-Related Aberrant Behavior
BACKGROUND: As national opioid consumption in South Korea has soared, well-validated screening tools for opioid use disorder (OUD) have become indispensable. The aims of our study were to evaluate OUD using the Korean version of the CAGE-Adapted to Include Drugs (CAGE-AID) and the CAGE-Opioid (an alternative version of the CAGE-AID), and to investigate clinical predictors that might be useful to screen for OUD in conjunction with the CAGE-AID/Opioid questionnaires. METHODS: A single-center,...
Anesthesia & Analgesia - Current Issue
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A Prospective Observational Cohort Study of Calls for Help in a Tertiary Care Academic Operating Room Suite
While significant literature exists on hospital-based “code calls,” there is a lack of research on calls for help in the operating room (OR). The purpose of this study was to quantify the rate and nature of calls for help in the OR of a tertiary care hospital. For a 1-year period, all calls were recorded in the main OR at The University of California, Irvine Medical Center. The average rate of calls per 1000 anesthesia hours was 1.4 (95% CI, 1.1–1.8), corresponding to a rate of 5.0 (3.8–6.5) calls...
Anesthesia & Analgesia - Current Issue
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Parasympathetic Tone Activity Evaluation to Discriminate Ketorolac and Ketorolac/Tramadol Analgesia Level in Swine
BACKGROUND: Evaluation of nociceptive–antinociceptive balance during general anesthesia is still challenging and routinely based on clinical criteria. Analgesic drug delivered may be optimized with parasympathetic tone activity (PTA) monitor. This study compares ketorolac and ketorolac/tramadol balance analgesia using a PTA monitor. METHODS: Pain intensity response was assessed using a 0–100 numerical state scale (PTA) after nociceptive stimuli in pigs under stable sevoflurane anesthesia....
Anesthesia & Analgesia - Current Issue
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Postoperative Corneal Injuries: Incidence and Risk Factors
BACKGROUND: Previous studies of postoperative corneal injury rates relied on provider-initiated incident reports, which may underestimate the true incidence. Postoperative administration of proparacaine eye drops is used almost exclusively to diagnose corneal injury; therefore, identifying instances of administration may provide a better estimate of corneal injuries. We compared proparacaine administration versus provider-initiated reports to determine rates of corneal injury. In addition, potential...
Anesthesia & Analgesia - Current Issue
4m
Vasopressor Infusion During Prone Spine Surgery and Acute Renal Injury: A Retrospective Cohort Analysis
BACKGROUND: Hypotension is associated with acute kidney injury, but vasopressors used to treat hypotension may also compromise renal function. We therefore tested the hypothesis that vasopressor infusion during complex spine surgery is not associated with impaired renal function. METHODS: In this retrospective cohort analysis, we considered adults who had complex spine surgery between January 2005 and September 2014 at the Cleveland Clinic Main Campus. Our primary outcome was postoperative...
Anesthesia & Analgesia - Current Issue
4m
Reversing Cholinergic Bronchoconstriction by Common Inotropic Agents: A Randomized Experimental Trial on Isolated Perfused Rat Lungs
BACKGROUND: The ability of inotropic agents to alter airway reactivity and lung tissue mechanics has not been compared in a well-controlled experimental model. Therefore, we compared the potential to alter lung tissue viscoelasticity and bronchodilator effects of commonly used inotropic agents in an isolated perfused rat lung model. METHODS: After achieving steady state lung perfusion, sustained bronchoconstriction was induced by acetylcholine (ACh). Isolated rat lungs were then randomly...
Anesthesia & Analgesia - Current Issue
4m
Neuroanesthesia: A Problem-Based Learning Approach, 1st ed
No abstract available
Anesthesia & Analgesia - Current Issue
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The Impact of Postoperative Intensive Care Unit Admission on Postoperative Hospital Length of Stay and Costs: A Prespecified Propensity-Matched Cohort Study
BACKGROUND: In this prespecified cohort study, we investigated the influence of postoperative admission to the intensive care unit versus surgical ward on health care utilization among patients undergoing intermediate-risk surgery. METHODS: Of adult surgical patients who underwent general anesthesia without an absolute indication for postoperative intensive care unit admission, 3530 patients admitted postoperatively to an intensive care unit were matched to 3530 patients admitted postoperatively...
Anesthesia & Analgesia - Current Issue
4m
Co-existing Diseases and Neuroanesthesia
No abstract available
Anesthesia & Analgesia - Current Issue
4m
Fibrinolysis Shutdown in Trauma: Historical Review and Clinical Implications
Despite over a half-century of recognizing fibrinolytic abnormalities after trauma, we remain in our infancy in understanding the underlying mechanisms causing these changes, resulting in ineffective treatment strategies. With the increased utilization of viscoelastic hemostatic assays (VHAs) to measure fibrinolysis in trauma, more questions than answers are emerging. Although it seems certain that low fibrinolytic activity measured by VHA is common after injury and associated with increased mortality,...
Anesthesia & Analgesia - Current Issue
4m
Perioperative Pain Management for Orthopedic and Spine Surgery
No abstract available
Anesthesia & Analgesia - Current Issue
4m
Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways in gynecologic surgery have been shown to decrease length of stay with no impact on readmission, but no study has assessed predictors of admission in this population. The purpose of this study was to identify predictors of admission after laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RAH) performed under an ERAS pathway. METHODS: This is a prospective observational study of women undergoing LH/RAH for benign indications...
Anesthesia & Analgesia - Current Issue
4m
Anesthesia: A Topical Update – Thoracic, Cardiac, Neuro, ICU, and Interesting Cases [Book Series: Recent Advances in Anesthesiology, Volume 2]
No abstract available
Anesthesia & Analgesia - Current Issue
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Point-of-Care Fibrinogen Testing in Pregnancy
Agreement between estimated fibrinogen concentration via thromboelastography and traditional assays is not established in the parturient. We therefore recruited 56 parturients and performed Clauss and functional fibrinogen level (FLEV) tests. Mean difference of measurements was 36.8 mg/dL (95% CI, 21.8–51.9) with a standard deviation of 52.8 mg/dL. Calculated limits of agreement were 140.2 mg/dL (95% CI, 166.3–114.6) and −66.6 mg/dL (95% CI, −40.8 to −92.5), within the maximum allowable difference...
Anesthesia & Analgesia - Current Issue
4m
Ketamine-(Dex)Medetomidine, Hyperglycemia, Glycocalyx, and Vascular Permeability
No abstract available
Anesthesia & Analgesia - Current Issue
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The Effect of Labor Epidural Analgesia on Breastfeeding Outcomes: A Prospective Observational Cohort Study in a Mixed-Parity Cohort
BACKGROUND: The effect of labor epidural analgesia (LEA) on successful breastfeeding has been evaluated in several studies with divergent results. We hypothesized that LEA would not influence breastfeeding status 6 weeks postpartum in women who intended to breastfeed in an environment that encourages breastfeeding. METHODS: In this prospective observational cohort study, a total of 1204 women intending to breastfeed, delivering vaginally with or without LEA, were included; breastfeeding was...
Anesthesia & Analgesia - Current Issue
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Another Nail in the Coffin of the Practice of Checking Mask Ventilation Before Administration of a Muscle Relaxant
No abstract available
Anesthesia & Analgesia - Current Issue
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Distraction-Free Induction Zone: A Quality Improvement Initiative at a Large Academic Children’s Hospital to Improve the Quality and Safety of Anesthetic Care for Our Patients
BACKGROUND: Noise in the operating room may cause distractions during critical periods and impair reliable communication between staff. Even momentary inefficiency while administering anesthesia can lead to errors and serious consequences for the patient. Distractions to an anesthesia provider during critical periods such as induction and emergence are a patient safety issue. Because of concerns regarding unacceptable noise levels and distractions during induction of general anesthesia, our institution...
Anesthesia & Analgesia - Current Issue
4m
Postoperative Respiratory Depression May Be Related to Undiagnosed Sleep-Disordered Breathing or Obstructive Sleep Apnea
No abstract available
Anesthesia & Analgesia - Current Issue
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Variability and Costs of Low-Value Preoperative Testing for Carpal Tunnel Release Surgery
BACKGROUND: The American Society of Anesthesiologists (ASA) Choosing Wisely Top-5 list of activities to avoid includes “Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery - specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal.” Accordingly, we define low-value preoperative tests (LVTs) as those performed before...
Anesthesia & Analgesia - Current Issue
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Is Tube Thermosoftening Helpful for Videolaryngoscope-Guided Nasotracheal Intubation?:: A Randomized Controlled Trial
BACKGROUND: Thermosoftening of the endotracheal tube (ETT) and telescoping the ETT into a rubber catheter have been suggested as a method for reducing epistaxis during nasotracheal intubation (NTI). However, thermosoftening technique is known to make it difficult to navigate the ETT into trachea without the use of Magill forceps during NTI. The cuff inflation technique has been suggested as an effective alternative to the use of Magill forceps to improve the oropharyngeal navigation of the ETT,...
Anesthesia & Analgesia - Current Issue
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Initial Postoperative Hemoglobin Values and Clinical Outcomes in Transfused Patients Undergoing Noncardiac Surgery
BACKGROUND: Intraoperative red blood cell (RBC) transfusion is common, yet transfusion strategies remain controversial as pretransfusion hemoglobin triggers are difficult to utilize during acute bleeding. Alternatively, postoperative hemoglobin values may provide useful information regarding transfusion practices, though optimal targets remain undefined. METHODS: This is a single-center observational cohort study of adults receiving allogeneic RBCs during noncardiac surgery from 2010 through...
Anesthesia & Analgesia - Current Issue
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Pilot Study: Neurocognitive Disorders and Colonoscopy in Older Adults
In a preoperative anesthesia setting with integrated neuropsychology for individuals >64 years of age, we completed a pilot study examining the association between neurocognitive disorders with frequency of missed colonoscopies and quality of bowel preparation (prep). Gastroenterologists completed the Boston Bowel Preparation Scale (BBPS) for each patient. Of 47 older adults seen in our service, 68% met criteria for neurocognitive disorders. All individuals failing to attend the colonoscopy procedure...
Anesthesia & Analgesia - Current Issue
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Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic
BACKGROUND: Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity...
Anesthesia & Analgesia - Current Issue
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Anesthesia Provider Training and Practice Models: A Survey of Africa
BACKGROUND: In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically...
Anesthesia & Analgesia - Current Issue
4m

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