Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 2008
The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation.
Intraoperative transfusion of red blood cells (RBC) is associated with adverse outcome after orthotopic liver transplantation (OLT). Although experimental studies have shown that platelets contribute to reperfusion injury of the liver, the influence of allogeneic platelet transfusion on outcome has not been studied in detail. In this study, we evaluate the impact of various blood products on outcome after OLT. ⋯ This retrospective study indicates that, in addition to RBC, platelet transfusions are an independent risk factor for survival after OLT. These findings have important implications for transfusion practice in liver transplant recipients.
-
Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialIs the combination of morphine with ketamine better than morphine alone for postoperative intravenous patient-controlled analgesia?
The addition of ketamine to morphine for patient-controlled analgesia (PCA) is supported by previous basic and clinical research, but has been challenged by subsequent negative studies. Important limitations of previous studies are the low number of patients analyzed, the use of morphine-ketamine combinations that may not the optimal, and that not all the relevant outcomes have been analyzed. In this study, we compared the combination of morphine and ketamine with morphine alone for postoperative PCA in large patient groups. We used a morphine-ketamine combination identified by an optimization procedure in our previous study. ⋯ Small-dose ketamine combined with morphine for PCA provides no benefit to patients undergoing major orthopedic surgery and cannot be recommended for routine use.
-
Anesthesia and analgesia · Jan 2008
Real-time checking of electronic anesthesia records for documentation errors and automatically text messaging clinicians improves quality of documentation.
The quality of electronic anesthesia documentation is important for downstream communication and to demonstrate appropriate diligence to care. Documentation quality will also impact the success of reimbursement contracts that require timely and complete documentation of specific interventions. We implemented a system to improve completeness of clinical documentation and evaluated the results over time. ⋯ Electronic anesthesia documentation performance can be rapidly managed and improved by using an automatic process monitoring and alerting system.
-
Anesthesia and analgesia · Jan 2008
The effectiveness of a simple novel approach on electroencephalograph instruction for anesthesiology residents.
The electroencephalogram (EEG) measures cerebral activity and, because of its use as an intraoperative monitor, the Accreditation Council for Graduate Medical Education requires EEG monitoring experience during anesthesiology residency. To improve the anesthesiology residents' education at the University of Kentucky, a new learning module was created in collaboration with a neurologist expert in EEGs. ⋯ This educational effort using the department of neurology expertise provided a significant improvement in EEG assessment tool scores.
-
Anesthesia and analgesia · Jan 2008
Clinical TrialContinuous infraclavicular brachial plexus block: a modified technique to better secure catheter position in infants and children.
The infraclavicular approach to the brachial plexus provides suitable anesthesia and also lends itself well to stabilizing and securing a catheter for a continuous infusion. We describe an approach for continuous infusions using an infraclavicular approach in children. ⋯ A modified technique for continuous infraclavicular brachial plexus block helps secure the catheter and provides effective intra- and postoperative pain relief in pediatric patients.