Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2006
Comparative StudyDuration of dialysis is a significant predictor of prolonged postoperative mechanical ventilation in dialysis-dependent patients undergoing cardiac surgery.
Prolonged mechanical ventilation is reported to correlate with increased risk of mortality after cardiac surgery. We designed the present study to determine the preoperative and intraoperative risk factors that could predict postoperative prolonged mechanical ventilation in dialysis-dependent patients undergoing cardiac surgery with cardiopulmonary bypass. Forty-four dialysis-dependent patients were divided into two groups; patients of group E were tracheally extubated within 24 h after admission to the intensive care unit postoperatively (n = 19) and patients of group L (n = 25) required more than 24 h of mechanical ventilation. ⋯ On admission to the intensive care unit, Pao2/Fio2 of group L was significantly lower than that of group E (294 +/- 135 versus 415 +/- 99 mm Hg) and the circulatory status of group L was worse than that of group E. The median (interquartile range) duration of intensive care unit stay in group E was 3 (3.00) days, which was significantly shorter than that of group L (5 [2.75] days). It is possible that longer surgery increases the likelihood of cardiac dysfunction and poor oxygenation in patients with a long history of dialysis.
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Anesthesia and analgesia · Jan 2006
Comparative StudyAccreditation Council for Graduate Medical Education competencies and the American Board of Anesthesiology Clinical Competence Committee: a comparison.
We compared the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project to the long-standing requirement of the American Board of Anesthesiology for a Clinical Competence Committee Report. There are many similarities between these two systems of resident evaluation. ⋯ In addition, the Clinical Competence Committee Report is primarily a summative evaluation for the purpose of assigning credit for training. The ACGME Outcome Project may be used as a component of a summative evaluation, but the primary emphasis is on formative assessment.
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Anesthesia and analgesia · Jan 2006
Case ReportsFires in the operating room and intensive care unit: awareness is the key to prevention.
Recent recommendations from the Centers for Disease Control (CDC) to use alcohol-based substances for hand hygiene and skin antisepsis could introduce new fire hazards in the operating room (OR). This potential for an increase in the number of fires in the hospital setting with wide spread use of alcohol-based agents warrants heightened awareness of the risks and implementation of safety measures when using these agents. Here, we report a patient who, during a tracheostomy, sustained severe burns resulting from a fire in the OR. In this case, the use of an alcohol-based antiseptic was the major contributing factor to the surgical fire.
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Anesthesia and analgesia · Jan 2006
Comparative StudyAn audible indication of exhalation increases delivered tidal volume during bag valve mask ventilation of a patient simulator.
Self-inflating manual resuscitators (SIMRs) can mislead caregivers because the bag, unlike a Mapleson-type device, reinflates even without patient exhalation. We added a whistle as an audible indicator to the exhalation port of a SIMR. In randomized order, each participant provided two sets of breaths via mask ventilation with a SIMR, one with and one without audible feedback, to a Human Patient Simulator modified to log lung volume changes. ⋯ Average Vt delivered with the standard SIMR was 486 +/- 166 mL and 624 +/- 96 mL with the modified SIMR. Average Vt delivered by a modified SIMR was significantly larger by 40% when it followed standard SIMR use and 19% when using the modified SIMR first. Use of a SIMR with an audible indicator of exhalation significantly (P < 0.001) increased mask ventilation of a patient simulator, suggesting that mask ventilation of a patient with a SIMR may also be increased by objective, real-time feedback of exhaled Vt.
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Anesthesia and analgesia · Jan 2006
Comparative StudyPredicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach.
Using a multiply matched, concurrent cohort analysis, with 568 subjects matched from data obtained by our laboratory over the past 7 yr, we examined whether parental presence during induction of anesthesia (PPIA) reduces children's anxiety depending on the interaction between child and parent's baseline anxiety. Children's and parents' baseline anxiety was assessed preoperatively; children's anxiety was again assessed during induction of anesthesia. ⋯ We found no effect of PPIA on children's anxiety during induction of anesthesia when calm parents accompanied calm children into the operating room (P = 0.15) or when overly anxious parents accompanied anxious children (P = 0.49). We conclude that the presence of a calm parent does benefit an anxious child during induction of anesthesia and the presence of an overly anxious parent has no benefit.