Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2006
Use of a modifier reduces inconsistency in the American Society of Anesthesiologists Physical Status Classification in parturients.
In this study, we sought to determine whether there is a significant discrepancy among a group of practitioners when rating pregnant patients using the ASA Physical Status Classification and whether this discrepancy could be resolved with the addition of a modifier for pregnancy. Our results indicate that significant discrepancy occurs and that it is reduced with the use of the modifier, especially when referring to the healthy parturient.
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Anesthesia and analgesia · Apr 2006
The role of anesthesiologists in the selection and administration of perioperative antibiotics: a survey of the American Association of Clinical Directors.
The importance of timely administration of antibiotics for prophylaxis of surgical site infections has led to pressure on anesthesiologists to administer antibiotics. We present a survey of members of the American Association of Clinical Directors designed to evaluate the role of the anesthesiologist in the selection and administration of perioperative antibiotics. ⋯ Based on the responses received, anesthesiologists appear to be integrally involved with the administration, but not selection, of perioperative antibiotics, despite what respondents perceive as inadequate training in antibiotic therapy. Furthermore, perioperative antibiotic therapy in general appears to be poorly monitored, and responsibility for selection and administration of perioperative antibiotics appears to be poorly defined.
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Anesthesia and analgesia · Apr 2006
Case ReportsInfusion pump delivers over-dosage of propofol as a result of missing syringe support.
We describe the malfunction of a common drug infusion pump. The syringe saddle was missing and allowed the syringe barrel to contact the pump case, which decreased the outward displacement of the syringe clamp. Then, the infusion pump falsely detected a smaller syringe size and consequently delivered an increased infusion rate and overdose of propofol to the patient. More commonly, an incorrectly mounted syringe may increase the outward displacement of the syringe clamp so that the infusion pump falsely detects a larger syringe size, with resultant less than expected infusion rate.
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Anesthesia and analgesia · Apr 2006
Comparative StudyAnticholinesterase drugs stimulate smooth muscle contraction of the rat trachea through the Rho-kinase pathway.
We performed this study to determine the effects of Rho-kinase inhibitors, Y-27632 and fasudil, on the anticholinesterase (anti-ChE)-induced contractile and phosphatidylinositol responses of the rat trachea. In vitro measurements of isometric tension and [3H] inositol monophosphate (IP1) that was formed were conducted by using rat tracheal rings or slices. ⋯ Neostigmine-induced IP1 accumulation was attenuated by fasudil at 100 microM. The results suggest that anti-ChEs cause airway smooth muscle contraction, in part, through activation of the Rho-kinase pathway.
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Anesthesia and analgesia · Apr 2006
The delivery of drugs to patients by continuous intravenous infusion: modeling predicts potential dose fluctuations depending on flow rates and infusion system dead volume.
IV drug infusion has the potential for dosing errors, which arise from complex interactions between carrier flows and the infusion set dead volume. We computed the steady-state mass of drug stored in the infusion set dead volume, using phenylephrine as a model compound. The mass of drug in the dead volume increases with stock drug concentration and desired dose but decreases with carrier flow rate. ⋯ This time is longest for large stock-drug concentrations, larger dead volumes, and slower final carrier rates. These computations illustrate that (a) the dead volume may contain a large mass of drug available for inadvertent bolus, (b) cessation of carrier flow can profoundly reduce drug delivery, and (c) after a change in carrier flow or drug dosing, a significant lag is possible before drug delivery achieves steady state. Although computed for phenylephrine, the concepts are generic and valid for any drug administered by IV infusion.