Anesthesiology
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Review Comparative Study
Injuries and liability related to central vascular catheters: a closed claims analysis.
To assess changing patterns of injury and liability associated with central venous or pulmonary artery catheters, the authors analyzed closed malpractice claims for central catheter injuries in the American Society of Anesthesiologists Closed Claims database. ⋯ Claims related to central catheters had a high severity of patient injury. The most common complications causing injury were wire/catheter embolus, cardiac tamponade, carotid artery puncture/cannulation, hemothorax, and pneumothorax.
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Randomized Controlled Trial Comparative Study Clinical Trial
Parental auricular acupuncture as an adjunct for parental presence during induction of anesthesia.
The purpose of this study was to determine whether parental auricular acupuncture reduces parental preoperative anxiety and thus allows children to benefit from parental presence during induction of anesthesia. ⋯ : Auricular acupuncture significantly decreased maternal anxiety during the preoperative period. Children of mothers who underwent acupuncture intervention benefitted from the reduction of maternal anxiety during the induction of anesthesia.
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Factors contributing to subarachnoid catheter passage after epidural placement are not well understood. This study explored mechanisms that might explain its occurrence. ⋯ Catheter passage is unlikely in the presence of intact dura or after an uncomplicated combined spinal-epidural. Unintentional subarachnoid passage suggests dural damage with the epidural needle.
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The authors have developed a new clinical bymixer that bypasses a constant fraction of gas flow through a mixing arm. A separate bymixer was interposed in the expiratory and inspiratory limbs of the ventilation circuit to measure mixed gas fractions. By utilizing nitrogen conservation, the clinical bymixer allows the determination of airway carbon dioxide elimination (VCO2) and oxygen uptake (VO2), whenever basic expired flow and gas monitoring measurements are used for the patient. Neither an expiratory exhaust gas collection bag nor expensive, complex equipment are needed. This study tested the accuracy of airway bymixer-flow measurements of VCO2 and VO2 in a new bench apparatus. ⋯ The new clinical bymixer, plus basic expired flow and gas fraction measurements, generated clinically accurate determinations of VCO2 and VO2. These measurements are helpful in the assessment of metabolic gas exchange in the critical care unit. In contrast to using the gas collection bag or complex metabolic monitor, the bymixer should measure mixed gas concentrations in the inspired or expired limb of the common anesthesia circle ventilation circuit.
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Comparative Study
Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube.
Formation of a bacterial biofilm within the endotracheal tube (ETT) after tracheal intubation is rapid and represents a ready source of lung bacterial colonization. The authors investigated bacterial colonization of the ventilator circuit, the ETT, and the lungs when the ETT was coated with silver-sulfadiazine and chlorhexidine in polyurethane, using no bacterial/viral filter attached to the ETT. ⋯ Coated ETTs induced a nonsignificant reduction of the tracheal colonization, eliminated (seven of eight) or reduced (one of eight) bacterial colonization of the ETT and ventilator circuits, and prevented lung bacterial colonization.