Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2011
Self-reported information needs of anesthesia residency applicants and analysis of applicant-related web sites resources at 131 United States training programs.
Despite the use of web-based information resources by both anesthesia departments and applicants, little research has been done to assess these resources and determine whether they are meeting applicant needs. Evidence is needed to guide anesthesia informatics research in developing high-quality anesthesia residency program Web sites (ARPWs). ⋯ Anesthesia residency applicants rely heavily on ARPWs to research programs, prepare for interviews, and formulate a rank list. Anesthesia departments can improve their ARPWs by including information such as total hours worked and work hours by rotation (missing in 96% and 97% of ARPWs) and providing a valid web address on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) (missing in 28% of ARPWs).
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Anesthesia and analgesia · Feb 2011
Do 0-10 numeric rating scores translate into clinically meaningful pain measures for children?
Self-reported pain scores are used widely in clinical and research settings, yet little is known about their interpretability in children. In this prospective, observational study we evaluated the relationship between 0 to 10 numerical rating scale (NRS) pain scores and other self-reported, clinically meaningful outcomes, including perceived need for medicine (PNM), pain relief (PR), and perceived satisfaction (PS) with treatment in children postoperatively. ⋯ This study provides important information regarding the clinical interpretation of NRS pain scores in children. Data further support the NRS as a valid measure of pain intensity in relation to the child's PNM, PR, and PS in the acute postoperative setting. However, the variability in scores in relation to other clinically meaningful outcomes suggests that application of cut-points for individual treatment decisions is inappropriate.
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Anesthesia and analgesia · Feb 2011
Comparative StudyHistological analysis after peripheral nerve puncture with pencil-point or Tuohy needletip.
Continuous peripheral nerve blocks typically are performed with a "through-the-needle technique" and require needles with an inner diameter allowing catheter placement. In case of direct needle-nerve contact, the pencil-point needletip is currently considered less traumatic than are other needle configurations. In this study we determined whether nerve puncture with pencil-point needles is associated with fewer nerve injuries in comparison with Tuohy needles. ⋯ Regardless of the needletip configuration applied for nerve puncture, pencil-point and Tuohy needletips may both lead to comparable magnitude of posttraumatic inflammation and considerable structural changes within the nerve. No significant differences were found comparing pencil-point with Tuohy tip-configured needles.
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Anesthesia and analgesia · Feb 2011
Measurement of dead space in subjects under general anesthesia using standard anesthesia equipment.
Pulmonary dead space is the volume of gas that is delivered to the lungs but does not participate in gas exchange. Knowing pulmonary dead space in patients under general anesthesia is clinically useful because it can aid in detecting disease processes such as pulmonary emboli or low cardiac output states. Dead space can be simply calculated by using the Bohr equation; however, it is difficult to measure mixed exhaled carbon dioxide (PECO(2)) with a standard anesthesia machine. Previously, a study at our institution demonstrated the carbon dioxide (CO(2)) concentration in the bellows of a standard anesthesia machine is an accurate approximation of PECO(2). In this study, we used the bellows PECO(2) measurement and arterial CO(2) (PaCO(2)) to calculate pulmonary dead space. We verified the technique by adding known apparatus dead space volumes during anesthesia. ⋯ Our baseline dead space measurements were in the expected range under general anesthesia. When dead space was added, we were able to calculate that an increase in dead space occurred. Our calculation was more accurate after adding a 100-mL volume than after adding 200 mL. We present a simple way to detect trends in dead space in ventilated patients using a Narkomed GS anesthesia machine (Dräger Medical, Lübeck, Germany).