Anesthesiology
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Administrators need simple tools to quickly identify even small changes in the performance of perioperative systems. This applies both to established systems and to impact assessments of deliberate perioperative system design changes. ⋯ Statistical process control is useful for detecting changes in perioperative system performance, represented in this study by nonoperative time. The technique is able to detect changes quickly and to detect small changes over time.
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Age-related changes in nociception have been extensively studied in the past decades. However, it remains unclear whether in addition to the increased incidence of chronic illness, age-related changes in nociception contribute to increased prevalence of pain in the elderly. Although a great deal of evidence suggests that nociception thresholds increase with aging, other studies yield disparate results. The aim of this investigation was to longitudinally determine the effect of aging on nociception. ⋯ Using a novel and noninjurious nociception assay, the authors showed that over the life span of mice, current vocalization threshold to electrical stimuli changes in a U-shaped pattern. The findings support the notion that age-related changes in nociception are curvilinear, and to properly study and treat pain, the age of subjects should be considered.
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Acute pancreatitis has been linked to intestinal barrier dysfunction and systemic inflammatory response with high mortality. Thoracic epidural analgesia improves intestinal perfusion. The authors hypothesized that thoracic epidural analgesia influences microcirculation injury, inflammatory response, and outcome of acute pancreatitis in rats. ⋯ Thoracic epidural analgesia attenuated systemic response and improved survival in severe acute pancreatitis. These effects might be explained by improved mucosal perfusion.
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Editorial Comment
Blood glucose variability: a new paradigm in critical care?
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A fatal case of viridans streptococcus meningitis is reported, which occurred as a complication of epidural anesthesia. One hundred seventy-nine reported cases of post-dural puncture meningitis are reviewed. Evidence suggests that most cases are probably caused by contamination of the puncture site by aerosolized mouth commensals from medical personnel, some are caused from contamination by skin bacteria, and, less frequently, other cases are caused directly or hematogenously by spread from an endogenous infectious site. Controversy exists regarding prevention, surveillance, incidence, and treatment of this serious complication.