Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2012
ReviewWhat's new in obstetric anesthesia in 2011? Reducing maternal adverse outcomes and improving obstetric anesthesia quality of care.
This article accompanied the "What's New in Obstetric Anesthesia?" lecture presented at the Society for Obstetric Anesthesia and Perinatology Annual Meeting in May 2012. The invited lecturer reviewed the obstetric, obstetric anesthesiology, perinatology, and key medical literature published in 2011. This review identifies key topics and themes from the 2011 literature relevant to the science and clinical practice of obstetric anesthesiology and the interdisciplinary care of obstetric patients. Specific topics include health care policy issues that affect pregnant women, updated information on maternal mortality and morbidity, and clinical and outcomes-based research related to anesthetic practices for women undergoing cesarean delivery.
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Anesthesia and analgesia · Nov 2012
Clinical TrialSpeaking up is related to better team performance in simulated anesthesia inductions: an observational study.
Our goal in this study was to test the relationship between speaking up--i.e., questioning, correcting, or clarifying a current procedure--and technical team performance in anesthesia. Hypothesis 1: team members' higher levels of speaking up are related to higher levels of technical team performance. Hypothesis 2: team members will react to speaking up by either clarifying their procedure or initiating a procedural change. Hypothesis 3: higher levels of speaking up during an earlier phase of teamwork will be related to higher levels of speaking up during a later phase. ⋯ This study provides empirical evidence and shows mechanisms for the positive relationship between speaking-up behavior and technical team performance.
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Anesthesia and analgesia · Nov 2012
ReviewGeneral anesthesia: a gateway to modulate synapse formation and neural plasticity?
Appropriate balance between excitatory and inhibitory neural activity patterns is of utmost importance in the maintenance of neuronal homeostasis. General anesthetic-induced pharmacological interference with this equilibrium results not only in a temporary loss of consciousness but can also initiate long-term changes in brain function. Although these alterations were initially considered deleterious, recent observations suggest that at least under some specific conditions, they may eventually improve neural function. ⋯ Recent series of observations suggesting a developmental stage-dependent impact of these drugs on synaptogenesis will then be summarized together with currently known molecular mechanisms underlying these effects. Particular emphasis will be placed on how anesthetic drugs modulate neural plasticity in the adult brain and how this may improve neural function under some pathological states. The ensemble of these new observations strongly suggests that general anesthetics should not merely be considered toxic drugs but rather acknowledged as robust, context-dependent modulators of neural plasticity.
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Anesthesia and analgesia · Nov 2012
Use of analgesic, anesthetic, and sedative medications during pediatric hospitalizations in the United States 2008.
The wide need for analgesia, anesthesia, and sedation in children and the lack of pediatric labeling leads to widespread off-label use of medications for pain and sedation in children. Any attempt to address the lack of labeling will require national estimates of the numbers of children using each medication, their ages, and other factors, to understand the overall use of these medications. We describe use of analgesics, anesthetics, and sedatives in pediatric inpatients by result of conducting a statistical analysis of medication data from >800,000 pediatric hospitalizations in the United States. The purpose was to provide national estimates for the percentage of hospitalized children receiving specific analgesics, anesthetics, and sedatives and their use by age group. ⋯ A variety of drug classes and individual medications were used to manage pain and sedation in hospitalized children. The variation in patterns of use reflects the heterogeneity of the dataset, comprising a wide range of ages and conditions in which analgesia, anesthesia, and sedation might be required. It was not possible to assess whether use of a specific medication was clinically appropriate, except to note use of medications in age subgroups without pediatric labeling.