Anesthesia and analgesia
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Anesthetic drugs have the potential to contribute to global warming. There is some debate about the overall impact of anesthetic drugs relative to carbon dioxide, but there is no question that practice patterns can limit the degree of environmental contamination. In particular, careful attention to managing fresh gas flow can use anesthetic drugs more efficiently--reducing waste while achieving the same effect on the patient. ⋯ This article provides background information and discusses strategies for managing fresh gas flow during each phase of anesthesia with the goal of reducing waste when using a circle anesthesia system. Monitoring oxygen and anesthetic gas concentrations is essential to implementing these strategies safely and effectively. Future technological advances in anesthetic delivery systems are needed to make it less challenging to manage fresh gas flow.
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Anesthesia and analgesia · May 2012
Meta AnalysisUnplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations.
In this study, we updated the state of knowledge on unplanned tracheal extubations in the intensive care unit. We focused on the following topics: incidence, risk factors, reintubation after unplanned extubation, outcomes, and prevention. Based on this review, recommendations were made for preventing unplanned extubations. ⋯ Despite numerous publications on unplanned extubation, few studies assess preventive strategies for adverse events, and few clinical trials have assessed unplanned extubations. Recommendations are proposed based on the currently available literature.
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Anesthesia and analgesia · May 2012
ReviewThe current status of continuous noninvasive measurement of total, carboxy, and methemoglobin concentration.
Intraoperative early detection of anemia, identifying toxic levels of carboxyhemoglobin after carbon monoxide exposure and titrating drug dosage to prevent toxic levels of methemoglobin are important goals. The pulse oximeter works by illuminating light into the tissue and sensing the amount of light absorbed. ⋯ Currently there are 2 commercial pulse oximeters (Masimo Rainbow SET and OrSense NBM-200MP) that measure total hemoglobin concentration and one (Masimo) that also measures methemoglobin and carboxyhemoglobin. In this review, we describe the peer-reviewed literature addressing the accuracy of these monitors.
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Anesthesia and analgesia · May 2012
Brief report: identification of the great auricular nerve by ultrasound imaging and transcutaneous nerve stimulation.
Superficial cervical plexus neuropathy after interscalene brachial plexus block affects about 8% of patients postoperatively. One of the nerves involved in superficial cervical plexus neuropathy is the great auricular nerve. ⋯ Identification of the nerve is significantly more difficult in female and in obese patients. Further studies will allow determination of whether this information will help to reduce the incidence of superficial cervical plexus neuropathy.
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Anesthesia and analgesia · May 2012
A life cycle assessment of reusable and single-use central venous catheter insertion kits.
For most items used in operating rooms, it is unclear whether reusable items are environmentally and financially advantageous in comparison with single-use variants. We examined the life cycles of reusable and single-use central venous catheter kits used to aid the insertion of single-use, central venous catheters in operating rooms. We did not examine the actual disposable catheter sets themselves. We assessed the entire financial and environmental costs for the kits, including the influence of the energy source used for sterilization. ⋯ Inclusive of labor, the reusable central venous catheter insertion kits were less expensive than were the single-use kits. For our hospital, which uses brown coal-sourced electricity, the environmental costs of the reusable kit were considerably greater than those of the single-use kit. Efforts to reduce the environmental footprint of reusable items should be directed towards decreasing the water and energy consumed in cleaning and sterilization. The source of hospital electricity significantly alters the relative environmental effects of reusable items.