Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Core hypothermia and skin-surface temperature gradients. Epidural versus general anesthesia and the effects of age.
Inadvertent hypothermia occurs frequently during surgery and may be associated with adverse outcomes. Although various anesthetic agents have been shown to impair thermoregulation, the impairment with regional and general anesthetics has not been directly compared. ⋯ The EA and GA groups had virtually identical core temperature profiles during the intraoperative and post-operative periods. Comparison of skin-surface gradients suggests that EA is associated with less intraoperative upper-body thermoregulatory impairment but greater and persistent post-operative lower-body impairment. During EA, younger patients appeared to maintain thermoregulatory activity relative to the older patients. In patients receiving GA, the age-related differences were minimal.
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Randomized Controlled Trial Comparative Study Clinical Trial
The laryngeal mask airway and positive-pressure ventilation.
The utility of the laryngeal mask airway during positive-pressure ventilation has yet to be determined. Our study was designed to assess whether significant leaks occurred with positive-pressure ventilation and if leaks were associated with gastroesophageal insufflation. ⋯ Ventilation using the laryngeal mask appears to be adequate if airway resistance and pulmonary compliance are normal. Gastroesophageal insufflation of air will become a problem in the presence increased ventilation pressure.
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Clinical Trial
Characterization of prothrombin activation during cardiac surgery by hemostatic molecular markers.
Prothrombin activation represents the key regulatory step in the hemostatic process. Once formed, thrombin contributes to the generation of fibrin as well as the activation of platelets and fibrinolysis. Failure to suppress thrombin formation during cardiac surgery could result in disorders of hemostasis and thrombosis in the perioperative period. The aim of this study was to determine the time course for prothrombin activation during the perioperative period associated with cardiac surgery. ⋯ These data clearly demonstrate the occurrence of prothrombin activation and thrombin activity during CPB despite heparin concentrations adequate to maintain the activated clotting time greater than 400 s. Hemostatic markers for the activation of prothrombin demonstrated peak concentrations 3 h after completion of CPB with a return to baseline concentrations by the morning after surgery. Markers for thrombin activity, however, suggest the presence of active thrombin through the morning after surgery. Further investigations will be necessary to determine the role of hemostatic activation in thrombotic complications after cardiac surgery.
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Comparative Study
Comparison of forced-air patient warming systems for perioperative use.
Perianesthetic hypothermia is common and produces several complications, including postoperative shivering, decreased drug metabolism and clearance, and impaired wound healing. Forced-air warming transfers more than 50 W to the body and is an efficient method for either preventing or reversing decreases in core temperature. ⋯ The advantages of the Bair Hugger system and Warming Cover are evident in areas that are important for heat transfer from the periphery to the body core (chest, axilla, abdomen, and upper legs).
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Comparative Study Clinical Trial
Monitor surveillance and vigilance of anesthesia residents.
Anesthesia residents take longer to detect changes in electronically monitored data during the induction phase of anesthesia during the maintenance phase. This study was performed to investigate the reasons for this delay and to validate a method of measuring vigilance. ⋯ The results suggest that during induction of anesthesia, which is a period of high anesthesiologist workload, residents glance toward monitors to gather data rather than scan displays. The results help to validate the method for measuring anesthesia vigilance.