Anesthesia and analgesia
-
Anesthesia and analgesia · Jun 2012
Comparative StudyPerformance validation of a modified magnetic resonance imaging-compatible temperature probe in children.
During magnetic resonance imaging (MRI), children are at risk for body temperature variations. The cold MRI environment that preserves the MRI magnet can cause serious hypothermia. On the other hand, hyperthermia may also develop because of radiofrequency-induced heating of the tissues, particularly in prolonged examinations. Because of a lack of MRI-compatible core temperature probes, temperature assessment is unreliable, and specific absorption rate-related patient heat gain must be calculated to determine the allowable scan duration. We compared an MRI-compatible temperature probe and a modification thereof to a standard esophageal core body temperature probe in children. ⋯ Our results show good agreement between standard esophageal measurements of core temperature and core temperature measured using a modified MRI-core probe during general anesthesia in a general surgical pediatric population. The ability to accurately assess core temperature in the MRI suite may safely allow longer scan times and therefore reduce repeat anesthetic exposure, improve patient safety, and enhance the quality of care in children.
-
Anesthesia and analgesia · Jun 2012
Acute kidney injury after lung resection surgery: incidence and perioperative risk factors.
Postoperative acute kidney injury (AKI) is associated with increased perioperative morbidity and mortality in a variety of surgical settings, but has not been well studied after lung resection surgery. In the present study, we defined the incidence of postoperative AKI, identified risk factors, and clarified the relationship between postoperative AKI and outcome in patients undergoing lung resection surgery. ⋯ Preoperative risk factors for AKI after lung resection surgery overlap with those established for other surgical procedures. Perioperative management seems to influence the risk of AKI after lung resection; in particular, the use of synthetic colloids may increase the risk, whereas thoracoscopic procedures may decrease the risk of AKI. Early postoperative AKI is associated with respiratory complications and prolonged hospitalization.
-
Anesthesia and analgesia · Jun 2012
Availability of anesthesia equipment in Chinese hospitals: is the safety of anesthesia patient care assured?
Availability of physiologic monitoring equipment to ensure the safe administration of anesthesia is an expected standard in many parts of the world. Many hospitals in China may not have an adequate quantity and variety of anesthesia delivery and patient monitoring equipment to assure safe administration of anesthesia patient care. We present some typical cases of hospitals of different sizes and located in regions with different economic levels; our data demonstrate that there is a lack of available anesthesia administration and patient monitoring equipment in small hospitals and hospitals in economically underdeveloped regions.
-
Anesthesia and analgesia · Jun 2012
Comparative StudyFactor XIII and tranexamic acid but not recombinant factor VIIa attenuate tissue plasminogen activator-induced hyperfibrinolysis in human whole blood.
Hyperfibrinolysis is a pathological state that often results in depletion of coagulation factors and platelets and can contribute to bleeding. Factor XIII (FXIII) and thrombin activatable fibrinolysis inhibitor have key roles in protecting clots against fibrinolysis. We tested the hypotheses that FXIII concentrate, prothrombin complex concentrate (PCC), recombinant factor VIIa (rFVIIa), and tranexamic acid (TA) inhibit fibrinolysis to different degrees, and that platelets contribute to antifibrinolysis. ⋯ In thromboelastometric assays using whole blood, only TA, FXIII, and PCC significantly inhibited r-tPA-evoked hyperfibrinolysis whereas rFVIIa had no effect. We also found that the effects of exogenous FXIII were dependent on the presence of functional platelets.
-
Anesthesia and analgesia · Jun 2012
The variability of response to propofol is reduced when a clinical observation is incorporated in the control: a simulation study.
When using a target-controlled infusion of propofol to produce sedation, the operator assumes that the individual patient's pharmacokinetic parameters match those in the control system so that the specified effect-site target is achieved, and that the specified target is appropriate for the individual patient's sensitivity. These inaccuracies cascade, and this produces error in the desired level of sedation, termed "target error." To address this issue, we designed a control system that incorporates the operator's observation of loss of responsiveness to determine patient sensitivity. Our hypothesis was that this control system would reduce the impact of pharmacokinetic parameter error and uncertainty in sensitivity on the system's target error. ⋯ Our system reduces the impact of biological variability by including the operator in the control loop. The utility of this approach in clinical practice will require further evaluation.