Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2012
ReviewThe disclosure of unanticipated outcomes of care and medical errors: what does this mean for anesthesiologists?
The disclosure of unanticipated outcomes to patients, including medical errors, has received considerable attention of late. The discipline of anesthesiology is a leader in patient safety, and as the doctrine of full disclosure gains momentum, anesthesiologists must become acquainted with these philosophies and practices. Effective disclosure can improve doctor-patient relations, facilitate better understanding of systems, and potentially decrease medical malpractice costs. ⋯ Anesthesiologists should be aware of the emerging best practices surrounding disclosure, as well as the training opportunities and disclosure support resources that are increasingly available. Innovative models should be developed that promote collaboration between all perioperative team members in the disclosure process. There are important opportunities for anesthesiologists to play a leading role in defining specialty-specific disclosure practices and to more effectively meet patients' needs for disclosure after unanticipated outcomes and medical errors.
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Anesthesia and analgesia · Mar 2012
Randomized Controlled Trial Comparative StudyBarriers to adverse event and error reporting in anesthesia.
Although anesthesiologists are leaders in patient safety, there has been little research on factors affecting their reporting of adverse events and errors. First, we explored the attitudinal/emotional factors influencing reporting of an unspecified adverse event caused by error. Second, we used a between-groups study design to ask whether there are different perceived barriers to reporting a case of anaphylaxis caused by an error compared with anaphylaxis not caused by error. Finally, we examined strategies that anesthesiologists believe would facilitate reporting. Where possible, we contrasted our results with published findings from other physician groups. ⋯ The majority of anesthesiologists in our study did not agree that the attitudinal/emotional barriers surveyed would influence reporting of an unspecified adverse event caused by error, with the exception of the barrier of being concerned about blame by colleagues. The probable influence of 6 perceived barriers to reporting a specified adverse event of anaphylaxis differed with the presence or absence of error. Anesthesiologists in our study supported assistive reporting strategies. There seem to be some differences between our results and previously published research for other physician groups.
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Anesthesia and analgesia · Mar 2012
Comparative StudySystemic lidocaine does not attenuate hepatic dysfunction after liver surgery in rats.
Lidocaine has been shown to attenuate ischemia-reperfusion (I/R) injury in the heart, lung, and brain, potentially due to modulation of inflammatory responses and apoptotic signaling pathways. Because hepatic I/R injury after liver surgery still poses a significant risk for postoperative liver dysfunction or even failure, we investigated whether systemic lidocaine would also positively affect hepatocellular damage and overall liver function after hepatic I/R injury. In addition the potential underlying mechanisms of action were studied. ⋯ Systemic lidocaine in therapeutic concentrations neither attenuated hepatocellular damage nor improved postoperative liver function after hepatic I/R injury.
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Anesthesia and analgesia · Mar 2012
Comparative StudyIs alcohol-based hand disinfection equivalent to surgical scrub before placing a central venous catheter?
Waterless antiseptic surgical hand scrub (1% chlorhexidine gluconate and 61% ethyl alcohol, Avagard™; 3M Health Care, St. Paul, MN), alcohol-only cleanser (62% ethyl alcohol), and traditional surgical scrub (5-minute scrub with 4% chlorhexidine soap using a sterile scrub brush with water) are techniques used for hand cleansing and disinfection. We hypothesized that alcohol-only cleanser and waterless antiseptic scrub (Avagard) would be as effective as a traditional surgical scrub for hand cleansing before placement of central venous catheters. ⋯ As the initial cleansing method, the alcohol-only cleanser (method 3) was significantly less effective than the traditional surgical scrub (method 1) (P < 0.001).
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Anesthesia and analgesia · Mar 2012
Randomized Controlled Trial Comparative StudyFresh and stored red blood cell transfusion equivalently induce subclinical pulmonary gas exchange deficit in normal humans.
Transfusion can cause severe acute lung injury, although most transfusions do not seem to induce complications. We tested the hypothesis that transfusion can cause mild pulmonary dysfunction that has not been noticed clinically and is not sufficiently severe to fit the definition of transfusion-related acute lung injury. ⋯ RBC transfusion causes subtle pulmonary dysfunction, as evidenced by impaired gas exchange for oxygen, supporting our hypothesis that lung impairment after transfusion includes a wide spectrum of physiologic derangements and may not require an existing state of altered physiology. These data do not support the hypothesis that transfusion of RBCs stored for >21 days is more injurious than that of fresh RBCs.