Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2009
Comparative StudyThe effects of lung recruitment on the Phase III slope of volumetric capnography in morbidly obese patients.
In this study, we analyzed the effect of the alveolar recruitment strategy (ARS) and positive end-expiratory pressure (PEEP) titration on Phase III slope (S(III)) of volumetric capnography (VC) in morbidly obese patients. ⋯ The S(III) in VC was useful to detect the optimal level of PEEP after lung recruitment in anesthetized morbidly obese patients.
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Anesthesia and analgesia · Jul 2009
Comparative StudyEliminating arterial injury during central venous catheterization using manometry.
Unintended arterial puncture occurs in 2%-4.5% of central venous catheterizations, resulting in arterial injury in 0.1%-0.5% of patients. Routine performance of manometry during catheterization may successfully identify unintended arterial puncture and avoid arterial cannulation and injury. ⋯ Consistent use of manometry, to verify venous placement, during central venous catheterization effectively eliminated arterial injury from unintended arterial cannulation during the 15-yr assessment.
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Anesthesia and analgesia · Jul 2009
Comparative StudyThe association of renal dysfunction and the use of aprotinin in patients undergoing congenital cardiac surgery requiring cardiopulmonary bypass.
The use of large-dose aprotinin during cardiopulmonary bypass (CPB) in adult patients has been linked to postoperative renal dysfunction, but its effect on the pediatric population undergoing complex congenital cardiac operations is not well defined. ⋯ Patients who receive aprotinin are more likely to present with preoperative risk factors for the development of postoperative renal dysfunction. However, when associated risk factors are properly considered, the use of aprotinin does not seem to be associated with a higher risk of developing renal dysfunction in the immediate postoperative period in children.
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Anesthesia and analgesia · Jul 2009
Comparative Study Historical ArticleA historical perspective on resident evaluation, the Accreditation Council for Graduate Medical Education Outcome Project and Accreditation Council for Graduate Medical Education duty hour requirement.
The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, endorsed at the 1999 ACGME annual meeting, was intended to shift the focus of residency program requirements and accreditation from process-oriented assessment to an assessment of outcomes. The Outcome Project established six general competencies, each of which is supported by more specific competencies. ⋯ The remarkable similarities between the qualities assessed in the 1917 evaluation and the assessment of contemporary ACGME competencies suggest that a common set of desirable physician characteristics and behaviors can be identified and measured.
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Anesthesia and analgesia · Jul 2009
Comparative StudyLiability related to peripheral venous and arterial catheterization: a closed claims analysis.
Serious complications after peripheral IV and arterial vascular cannulations have been reported. To assess liability associated with these peripheral vascular catheters for anesthesiologists, we reviewed claims in the American Society of Anesthesiologists Closed Claims database. ⋯ Claims related to IV catheters were an important source of liability for anesthesiologists, approximately half of which resulted from extravasation of drugs or fluid. Claims related to radial arterial catheterization were uncommon.