Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2008
Comparative StudyNoninvasive cardiac output determination using applanation tonometry-derived radial artery pulse contour analysis in critically ill patients.
Conventional thermodilution cardiac output (CO) monitoring is limited mainly to intensive care units and operating rooms because it requires the use of invasive techniques. To reduce the potential for complications and to broaden the applicability of hemodynamic monitoring, noninvasive methods for CO determination are being sought. Applanation tonometry allows noninvasive CO estimation through pulse contour analysis, but the method has not been evaluated in critically ill patients. ⋯ There was no significant difference in bias between the patients who were receiving vasopressor support and those who were not (P = 0.874) or between patients with good and poor applanation tonometry pressure waveform signal quality (P = 0.071). Whereas a significant increase in the invasively determined CO was observed when a fluid bolus was administered (n = 7, P = 0.016), these changes were not reflected by the noninvasive method. We conclude that radial artery applanation tonometry is not suitable to determine CO in critically ill hemodynamically unstable patients.
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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.
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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.
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Anesthesia and analgesia · Jan 2008
Case ReportsNonfatal cerebral air embolism after dental surgery.
After removal of four impacted third molars under general anesthesia, our patient developed subcutaneous emphysema, pneumothorax, pneumopericardium, and pneumomediastinum. Soon thereafter, coma with generalized epileptic status ensued. ⋯ The likely mechanism was injection of air by the high-speed dental drill through the soft tissue adjacent to the roots of the lower molars. We were unable to find any previous report of systemic air embolism after oral surgery.
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Anesthesia and analgesia · Jan 2008
Comparative StudyA comparison of two emergency cricothyroidotomy kits in human cadavers.
We compared two emergency cricothyroidotomy kits designed to avoid lesions during insertion, one based on the Seldinger technique (ST), the other based on the concept of a mechanical detection of the posterior wall of the larynx, with regard to insertion time, success rate, and complication rate. ⋯ In this model, despite a shorter insertion time, the NT produced more lesions and more failures than the ST.