Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2010
Comparative StudyOxygen delivery during transtracheal oxygenation: a comparison of two manual devices.
The Manujet™ and the ENK Oxygen Flow Modulator™ (ENK) deliver oxygen during transtracheal oxygenation. We sought to describe the ventilation characteristics of these 2 devices. ⋯ This study confirms the absolute necessity of allowing gas exhalation between 2 insufflations and maintaining low respiratory rates during transtracheal oxygenation. In the case of total airway obstruction, the ENK may be less deleterious because it has a pressure release vent. Using a Manujet at lower driving pressures may decrease the risk of barotrauma and allow the safe use of higher respiratory rates.
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Anesthesia and analgesia · Oct 2010
Comparative StudySpecial article: an optimistic prognosis for the clinical utility of laboratory test data.
It is hoped that anesthesiologists and other clinicians will be able to increasingly rely upon laboratory test data to improve the perioperative care of patients. However, it has been suggested that in order for a laboratory test to have clinically useful diagnostic performance characteristics (sensitivity and specificity), its performance must be considerably better than those that have been evaluated in most etiologic or epidemiologic studies. This pessimism about the clinical utility of laboratory tests is based upon the untested assumption that laboratory data are normally distributed within case and control populations. ⋯ By evaluating the effect that the data distribution has on laboratory test performance, we have arrived at the more optimistic outlook that it is feasible to produce laboratory tests with diagnostically useful performance characteristics. We also show that moderate errors in the classification of outcome variables (e.g., death vs. survival at a specified end point) have a small impact on test performance, which is of importance for outcomes research that uses anesthesia information management systems. Because these analyses typically seek to identify factors associated with an undesirable outcome, the data distributions of the independent variables need to be considered when interpreting the odds ratios obtained from such investigations.
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Anesthesia and analgesia · Oct 2010
Comparative StudyThe effect of ketamine anesthesia on the immune function of mice with postoperative septicemia.
It is unknown how ketamine anesthesia immunologically affects the outcome of patients with postoperative septicemia. We investigated the effects of ketamine anesthesia on mice with an Escherichia coli or lipopolysaccharide (LPS) challenge after laparotomy, focusing on phagocytosis by liver macrophages (Kupffer cells) and cytokine production. ⋯ Ketamine suppresses TNF production and phagocytosis by Kupffer cells/macrophages. Therefore, unless bacterial growth is well controlled (by an antibiotic), postoperative infection might not improve despite reduction of the inflammatory response.
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Anesthesia and analgesia · Oct 2010
Special article: personal protective equipment for care of pandemic influenza patients: a training workshop for the powered air purifying respirator.
Virulent respiratory infectious diseases may present a life-threatening risk for health care professionals during aerosol-generating procedures, including endotracheal intubation. The 2009 Pandemic Influenza A (H1N1) brings this concern to the immediate forefront. The Centers for Disease Control and Prevention have stated that, when performing or participating in aerosol-generating procedures on patients with virulent contagious respiratory diseases, health care professionals must wear a minimum of the N95 respirator, and they may wish to consider using the powered air purifying respirator (PAPR). ⋯ We provide on line a PAPR training workshop. Supporting information is presented here. Anesthesia and critical care providers may use this workshop to supplement, but not substitute for, the manufacturers' detailed use and maintenance instructions.