Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2008
Preparation of the Dräger Fabius anesthesia machine for the malignant-hyperthermia susceptible patient.
Anesthesia machines must be flushed of halogenated anesthetics before use in patients susceptible to malignant hyperthermia. We studied the kinetics of sevoflurane clearance in the Dräger Fabius anesthesia machine and compared them to a conventional anesthesia machine (Dräger Narkomed GS). ⋯ Preparation of the Dräger Fabius anesthesia machine using conventional flushing techniques required almost 10 times as long as an older, conventional anesthesia machine. If a prolonged flush is impractical or impossible, we describe a procedure using an activated charcoal filter inserted on the inspiratory limb of the breathing circuit which can effectively scrub residual sevoflurane to a concentration < 5 ppm within 10 min. This procedure includes an initial 5 min flush without the activated charcoal filter followed by a 5 min flush with the charcoal filter, after which the machine is ready for use in the malignant hyperthermia-susceptible patient. The charcoal filter must remain on the machine for the remainder of the anesthetic, and the fresh gas flow should be maintained > or = 10 L/min for the first 5 min, and > or = 2 L/min thereafter.
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Anesthesia and analgesia · Dec 2008
A mission-based productivity compensation model for an academic anesthesiology department.
We replaced a nearly fixed-salary academic physician compensation model with a mission-based productivity model with the goal of improving attending anesthesiologist productivity. ⋯ Implementing a productivity-based faculty compensation model in an academic department was associated with increased mean supplemental pay with relatively fewer faculty. ASA units per month and ASA units per operating room full-time equivalent increased, and these metrics are the most likely drivers of the increased compensation. This occurred despite a slight decrease in clinical productivity as measured by ASA units per anesthetizing location. Academic and educational output was stable.
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Anesthesia and analgesia · Dec 2008
The effects of spinal anesthesia with lidocaine and sufentanil on lower urinary tract functions.
Spinal local anesthetics interrupt the micturition reflex; bladder function remains impaired until sensory block had regressed to the S3 segment. Intrathecal opioids cause dose-dependent suppression of detrusor contractility. We studied the effects of spinal anesthesia with a combination of lidocaine and sufentanil on lower urinary tract function. ⋯ Bladder contractility returns much later than recovery of sensory function in sacral dermatomes (S3) when hyperbaric lidocaine combined with sufentanil is used for spinal anesthesia.