Anesthesia and analgesia
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Approximately 25% of initial arteriovenous fistula (AVF) placements will fail as a result of thrombosis or failure to develop adequate vessel size and blood flow. Fistula maturation is impacted by patient characteristics and surgical technique, but both increased vein diameter and high fistula blood flow rates are the most important predictors of successful AVFs. Anesthetic techniques used in vascular access surgery (monitored anesthesia care, regional blocks, and general anesthesia) may affect these characteristics and fistula failure. ⋯ Use of regional blocks may improve the success of vascular access procedures by producing significant vasodilatation, greater fistula blood flow, sympathectomy-like effects, and decreased maturation time. However, a large-scale, prospective, clinical trial comparing the different anesthetic techniques is still needed to verify these findings.
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Anesthesia and analgesia · Sep 2009
Randomized Controlled TrialA novel skin-traction method is effective for real-time ultrasound-guided internal jugular vein catheterization in infants and neonates weighing less than 5 kilograms.
Internal jugular vein (IJV) catheterization in pediatric patients is sometimes difficult because of the small sizes of veins and their collapse during catheterization. To facilitate IJV catheterization, we developed a novel skin-traction method (STM), in which the point of puncture of the skin over the IJV is stretched upward with tape during catheterization. In this study, we examined whether the STM increases the cross-sectional area of the vein and thus facilitates catheterization. ⋯ STM facilitates IJV catheterization in infants and neonates weighing <5 kg by enlarging the IJV and preventing vein collapse.
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Anesthesia and analgesia · Sep 2009
Randomized Controlled TrialA Macintosh laryngoscope blade for videolaryngoscopy reduces stylet use in patients with normal airways.
Although most tracheal intubations with direct laryngoscopy are not performed with a styletted endotracheal tube, it is recommended that a stylet can be used with indirect videolaryngoscopy. Recently, there were several reports of complications associated with styletted endotracheal tubes and videolaryngoscopy. In this study, we compared three videolaryngoscopes (VLSs) in patients undergoing tracheal intubation for elective surgery: the GlideScope Ranger (GlideScope, Bothell, WA), the V-MAC Storz Berci DCI (Karl Storz, Tuttlingen, Germany), and the McGrath (McGrath series 5, Aircraft medical, Edinburgh, UK) and tested whether it is feasible to intubate the trachea of patients with indirect videolaryngoscopy without using a stylet. ⋯ The trachea of a large proportion of patients with normal airways can be intubated successfully with certain VLS blades without using a stylet, although the three studied VLSs clearly differ in outcome. The Storz VLS displaces soft tissues in the fashion of a classic Macintosh scope, affording room for tracheal tube insertion and limiting the need for stylet use compared with the other two scopes. Although VLSs offer several advantages, including better visualization of the glottic entrance and intubation conditions, a good laryngeal view does not guarantee easy or successful tracheal tube insertion. We recommend that the geometry of VLSs, including blade design, should be studied in more detail.
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Anesthesia and analgesia · Sep 2009
The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center.
Emergency airway management is a required skill for many anesthesiologists. We studied 10 yr of experience at a Level 1 trauma center to determine the outcomes of tracheal intubation attempts within the first 24 h of admission. ⋯ In the hands of experienced anesthesiologists, rapid sequence intubation followed by direct laryngoscopy is a remarkably effective approach to emergency airway management. An algorithm designed around this approach can achieve very high levels of success.
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Anesthesia and analgesia · Sep 2009
Seventh and eighth year follow-up on workforce and finances of the United States anesthesiology training programs: 2007 and 2008.
We sent follow-up financial and workforce surveys to 121 United States anesthesiology training programs in 2007 and 2008. Seventy-four respondents (61%) demonstrated a continued increase in the institutional support for faculty and stabilization in the number of open positions. Institutional support per faculty full time equivalent with certified nurse anesthetist support removed averages $109,000. A 7% open faculty position rate is characterized by a preponderance of generalists (31%) and pediatric (21%) anesthesiologists.