Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2013
ReviewThe Use of Cognitive Aids During Emergencies in Anesthesia: A Review of the Literature.
Cognitive aids are prompts designed to help users complete a task or series of tasks. They may take the form of posters, flowcharts, checklists, or even mnemonics. It has been suggested that the use of cognitive aids improves performance and patient outcomes during anesthetic emergencies; however, a systematic assessment of the evidence is lacking. ⋯ Cognitive aids should continue to be developed from established clinical guidelines where guidelines exist. They would also benefit from more extensive simulation-based usability testing before use. Further evidence is required to explore the effects of cognitive aids in anesthetic emergencies, how they affect team function, and their design considerations.
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Anesthesia and analgesia · Nov 2013
Randomized Controlled TrialA Phase Ib, Dose-Finding Study of Multiple Doses of Remimazolam (CNS 7056) in Volunteers Undergoing Colonoscopy.
We performed the first multiple dose study of remimazolam designed to assess both the feasibility of maintaining suitable sedation during colonoscopy and reversing the sedative effects of remimazolam with flumazenil. ⋯ Remimazolam has the attributes of a sedative drug, with success rates comparable with recent studies of other drugs. Remimazolam provided adequate sedation in 33 of 44 subjects undergoing colonoscopy, and its sedative effects were easily reversed with flumazenil.
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Anesthesia and analgesia · Nov 2013
Randomized Controlled Trial Comparative StudyA Comparison of Quincke and Whitacre Needles with Respect to Risk of Intravascular Uptake in S1 Transforaminal Epidural Steroid Injections: A Randomized Trial of 1376 Cases.
Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI. ⋯ To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.
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Anesthesia and analgesia · Nov 2013
Randomized Controlled Trial Comparative StudyA Comparison Between the Bonfils Intubation Fiberscope and McCoy Laryngoscope for Tracheal Intubation in Patients with a Simulated Difficult Airway.
The Bonfils Intubation Fibrescope (Bonfils) and the McCoy laryngoscope (McCoy) are airway devices designed to assist tracheal intubation in difficult cases. Individually, both the Bonfils and McCoy have demonstrated superiority to the Macintosh laryngoscope in a simulated difficult airway. In this study, we compared the Bonfils with the McCoy laryngoscope in patients whose tracheal intubation had been intentionally hindered. Our primary hypothesis was that there is a significant difference in the rate of success for tracheal intubation when using the Bonfils or McCoy laryngoscope in patients with an intentionally hindered airway. ⋯ In the hands of trained operators, there appears to be no clinically significant difference in success, time to intubation, or adverse outcomes, when comparing the Bonfils with the McCoy laryngoscope, in the setting of a simulated difficult airway. The choice to use either device should remain based on appropriate patient selection, available aids, individual operator's experience, and economic circumstances.
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Anesthesia and analgesia · Nov 2013
Automated, Real-Time Fresh Gas Flow Recommendations Alter Isoflurane Consumption During the Maintenance Phase of Anesthesia in a Simulator-Based Study.
The Low Flow Wizard (LFW) provides real-time guidance for user optimization of fresh gas flow (FGF) settings during general inhaled anesthesia. The LFW can continuously inform users whether it determines their FGF to be too little, efficient, or too much, and its color-coded recommendations respond in real time to changes in FGF performed by users. Our study objective was to determine whether the LFW feature, as implemented in the Dräger Apollo workstation, alters FGF selection and thereby volatile anesthetic consumption without affecting patient care. ⋯ Our data in a simulated anesthetic suggest that enabling the display of FGF efficiency data by the LFW results in a median percent reduction in volatile liquid anesthetic consumption rate of 53.2%. Since the lower limit of the 95% confidence interval for the median is 39.4%, this finding is likely to translate into cost savings and less waste anesthetic gas generated in the clinical setting and released into the atmosphere.