Anesthesia and analgesia
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Simulation can be used to teach technical skills, to evaluate clinician performance, to help assess the safety of the environment of care, and to improve teamwork. Each of these has been successfully demonstrated in obstetric anesthesia simulation. Task simulators for epidural placement, failed intubation, and blood loss estimation seem to improve performance. ⋯ Finally, simulation can effectively assess and teach teamwork tools and behaviors. It is unclear, however, how well the lessons learned in the simulated environment translate into improved behaviors or better care in the clinical setting, or whether simulation improves patient outcomes. More research is needed to help answer these questions.
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Anesthesia and analgesia · Jan 2012
Practice GuidelineSpecial article: Creation of a guide for the transfer of care of the malignant hyperthermia patient from ambulatory surgery centers to receiving hospital facilities.
Volatile anesthetics and/or succinylcholine may trigger a potentially lethal malignant hyperthermia (MH) event requiring critical care crisis management. If the MH triggering anesthetic is given in an ambulatory surgical center (ASC), then the patient will need to be transferred to a receiving hospital. Before May 2010, there was no clinical guide regarding the development of a specific transfer plan for MH patients in an ASC. MECHANISM BY WHICH THE STATEMENT WAS GENERATED: A consensual process lasting 18 months among 13 representatives of the Malignant Hyperthermia Association of the United States, the Ambulatory Surgery Foundation, the Society for Ambulatory Anesthesia, the Society for Academic Emergency Medicine, and the National Association of Emergency Medical Technicians led to the creation of this guide. EVIDENCE FOR THE STATEMENT: Most of the guide is based on the clinical experience and scientific expertise of the 13 representatives. The list of representatives appears in Appendix 1. The recommendation that IV dantrolene should be initiated pending transfer is also supported by clinical research demonstrating that the likelihood of significant MH complications doubles for every 30-minute delay in dantrolene administration (Anesth Analg 2010;110:498-507). ⋯ This guide includes a list of potential clinical problems and therapeutic interventions to assist each ASC in the development of its own unique MH transfer plan. Points to consider include receiving health care facility capabilities, indicators of patient stability and necessary report data, transport team considerations and capabilities, implementation of transfer decisions, and coordination of communication among the ASC, the receiving hospital, and the transport team. See Appendix 2 for the guide.
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Anesthesia and analgesia · Jan 2012
Clinical TrialCardiovascular effects of dexmedetomidine sedation in children.
Dexmedetomidine (DEX) affects heart rate (HR), mean arterial blood pressure, cardiac index (CI), stroke index (SI), and systemic vascular resistance index (SVRI) in adults. In this study we sought to determine whether similar effects occur in children undergoing DEX sedation. ⋯ DEX decreases CI in children and has a cumulative effect. For patients undergoing prolonged procedures HR and CI remained decreased at the time of discharge together with a decrease in SI and an increase in SVRI.
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Anesthesia and analgesia · Jan 2012
The relationship between preoperative and primary care blood pressure among veterans presenting from home for surgery: is there evidence for anesthesiologist-initiated blood pressure referral?
American College of Cardiology/American Heart Association guidelines describe the perioperative evaluation as "a unique opportunity to identify patients with hypertension"; however, factors such as anticipatory stress or medication noncompliance may induce a bias toward higher blood pressure, leaving clinicians unsure about how to interpret preoperative hypertension. Information describing the relationship between preoperative intake blood pressure and primary care measurements could help anesthesiologists make primary care referrals for improved blood pressure control in an evidence-based fashion. We hypothesized that the preoperative examination provides a useful basis for initiating primary care blood pressure referral. ⋯ A small bias toward higher DOS blood pressures relative to subsequent primary care measurements was observed. DOS factors predicted only a small proportion of the observed variation. Accounting for the observed bias, a 2-stage SBP threshold and a single-reading DBP threshold were highly specific though insensitive for identifying subsequent primary care blood pressure elevation.
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Anesthesia and analgesia · Jan 2012
Case ReportsCase report: automated machine checkout leaves an internal gas leak undetected: the need for complete checkout procedures.
We report a complete internal fresh gas flow disconnect within a Dräger Fabius GS anesthesia machine without any alarms being triggered. This was undetected primarily because of an incomplete machine checkout in which the step of ensuring proper gas flows by using a "test lung" was omitted. Machine-specific factors, however, also contributed to prevent diagnosis: (1) the machine passed its leak test because the flowmeter bobbin (i.e., floating ball) sealed the flowmeter when back pressure was applied; (2) the mechanical ventilator entrains room air, thus functioning in the absence of fresh gas flow; and (3) the electronic flow sensors functioned "appropriately" because the leak was downstream. Despite the advent of highly automated machines, manual checkout procedures remain crucial to minimizing undiagnosed failures.