Anesthesia and analgesia
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Anesthesia and analgesia · May 2004
Randomized Controlled Trial Clinical TrialInteractive music therapy as a treatment for preoperative anxiety in children: a randomized controlled trial.
In this study, we examined whether interactive music therapy is an effective treatment for preinduction anxiety. Children undergoing outpatient surgery were randomized to 3 groups: interactive music therapy (n = 51), oral midazolam (n = 34), or control (n = 38). The primary outcome of the study was children's perioperative anxiety. We found that children who received midazolam were significantly less anxious during the induction of anesthesia than children in the music therapy and control groups (P = 0.015 and P = 0.005, respectively). We found no difference in anxiety during the induction of anesthesia between children in the music therapy group and children in the control group. An analysis controlling for therapist revealed a significant therapist effect; i.e., children treated by one of the therapists were significantly less anxious than children in the other therapist group and the control group on separation to the operating room (OR) (P < 0.05) and on entrance to the OR (P < 0.05), but not on the introduction of the anesthesia mask (P = not significant). Children in the midazolam group were the least anxious even after controlling for therapist effect (P < 0.05). We conclude that music therapy may be helpful on separation and entrance to the OR, depending on the therapist. However, music therapy does not appear to relieve anxiety during the induction of anesthesia. ⋯ Depending on the music therapist, interactive music therapy may relieve anxiety on separation and entrance to the operating room but appears less effective during the induction of anesthesia.
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Anesthesia and analgesia · May 2004
Clinical TrialIs bilateral monitoring of cerebral oxygen saturation necessary during neonatal aortic arch reconstruction?
In this study, we measured cerebral oxygenation in both cerebral hemispheres by using near-infrared spectroscopy before, during, and after regional low-flow cerebral perfusion (RLFP) to determine whether bilateral monitoring was necessary. Neonates undergoing aortic arch reconstruction with RLFP were studied. The bilateral regional cerebral oxygenation index was measured and recorded at 1-min intervals during the following periods: 1) before bypass, 2) during bypass before RLFP, 3) during RLFP, 4) on bypass after RLFP, and 5) post-bypass. Before bypass and on bypass before RLFP, the correlation (r = 0.979 and 0.852) and agreement (mean bias, right versus left, 0 and +2) between hemispheres were excellent. During RLFP, however, correlation (r = 0.35) and agreement (mean bias of the right versus left side, +6.3) worsened and only partially returned to baseline values after RLFP. Nine of 19 patients had sustained differences in cerebral oxygen saturation of >10%, always with the left side values less than the right. Bilateral monitoring detects desaturation in the left cerebral hemisphere during RLFP. The long-term consequences of lower saturations on the left side of the brain are unclear. ⋯ Left-sided cerebral hemisphere oxygen saturation, measured with near-infrared spectroscopy, was less than right-sided cerebral oxygen saturation during regional low-flow cerebral perfusion used for neonatal aortic arch reconstruction.
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Anesthesia and analgesia · May 2004
The failure of retrograde autologous priming of the cardiopulmonary bypass circuit to reduce blood use after cardiac surgical procedures.
Hemodilution during cardiopulmonary bypass (CPB) is a primary risk factor for blood transfusion in cardiac surgical patients. Priming of the CPB circuit with the patients' own blood (retrograde autologous priming, RAP) is a technique used to limit hemodilution and reduce transfusion requirements. We designed this study to examine the impact of RAP on perioperative blood product use. Using a retrospective cohort study design, the medical records of all patients undergoing CPB (excluding circulatory arrest cases) by a single surgeon were examined. Data were collected over a 24-mo period when RAP was routinely used as a blood conservation strategy (RAP group, n = 257). This group was compared with a cohort of patients during the 24 mo immediately preceding the introduction of RAP into clinical practice (no RAP group, n = 288). A small, statistically insignificant reduction in the percentage of patients receiving packed red blood cells was observed in the RAP group (44% versus 51% no RAP, P = 0.083). No differences were found between the groups in the number of units of packed red blood cells, platelets, or fresh frozen plasma transfused throughout the perioperative period. These results suggest that overall, RAP does not offer a clinically important benefit as a blood conservation technique. ⋯ Priming of the cardiopulmonary bypass circuit with the patients' own blood (retrograde autologous priming) resulted in insignificant reductions in blood use in a large, unselected group of patients undergoing cardiac surgical procedures.
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Anesthesia and analgesia · May 2004
Multiple measures of anesthesia workload during teaching and nonteaching cases.
In this study, we sought to examine several measures of anesthesia provider workload during different phases of anesthesia care and during teaching and nonteaching cases. Clinical work was assessed in real-time during 24 general anesthetics performed by consenting anesthesia providers. Workload was measured using physiological (provider heart rate), psychological (self-assessment and observer rating), and procedural (response latency to an alarm light and workload density) techniques. Clinicians' heart rates, observer and self-reported workload scores, and nonteaching workload density were consistently increased during anesthetic induction and emergence compared with maintenance. In nonteaching cases, workload density correlated with heart rate and with psychological workload. Workload density during teaching cases did not decrease during the induction and was significantly greater than during nonteaching cases. Alarm-light response latency (a measure of clinical vigilance) was significantly prolonged during the teaching compared with nonteaching cases. These results suggest that intraoperative teaching increases the workload of the clinician instructor and may reduce vigilance during anesthesia care. Additionally, multiple workload measures may provide a more comprehensive profile of the work demands of clinical cases. ⋯ Psychological, physiological, and procedural workload measures during routine general anesthesia cases documented the increased work demands of induction and emergence. Intraoperative teaching increased workload and decreased vigilance, suggesting the need for caution when educating during patient care.