Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2013
Case ReportsCase report: Volitional delay of self-reported outcomes: insights from a case of intraoperative awareness with explicit recall.
Intraoperative awareness with explicit recall (AWR) is a self-reported outcome of interest in clinical practice, quality assurance initiatives, and clinical trials. Combining structured postoperative interviews with a preoperative description of AWR is assumed to ensure prompt patient disclosure. ⋯ Volitionally delayed self-reported outcomes may affect statistical comparisons in clinical trials and quality assurance initiatives, and delay the treatment of subsequent sequelae in clinical practice. This limitation should be considered, even when using structured outcome assessment and preoperative education.
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Anesthesia and analgesia · Feb 2013
Technical communication: First robotic ultrasound-guided nerve blocks in humans using the Magellan system.
Ultrasound-guided nerve blocks are becoming a standard of modern anesthesia. We developed a robotic system, Magellan, to perform nerve blocks using a remote control center. ⋯ We present the first human testing of a robotic ultrasound-guided nerve block system. The success rate was 100%. The total performance time was approximately 3 minutes to 4 minutes.
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Anesthesia and analgesia · Feb 2013
Incidence, predictors, and outcomes of perioperative stroke in noncarotid major vascular surgery.
Perioperative stroke is a potentially catastrophic complication of surgery. Patients undergoing vascular surgery suffer from systemic atherosclerosis and are expected to be at increased risk for this complication. We studied the incidence, predictors, and outcomes of perioperative stroke after noncarotid major vascular surgery using the American College of Surgeons National Quality Improvement Program database. ⋯ Perioperative stroke is an important source of morbidity and mortality, as reflected by significant increases in median surgical length of stay and all-cause 30-day mortality. The independent predictors of stroke that we have identified in this population are not readily modifiable and the majority of strokes occurred after postoperative day 1. Additional studies are required to identify potentially modifiable intraoperative or postoperative risk factors of perioperative stroke.
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Anesthesia and analgesia · Feb 2013
Case ReportsCase report: Perioperative pacemaker-mediated tachycardia in the patient with a dual chamber implantable cardioverter-defibrillator.
Patients with cardiac implantable electronic devices are at additional risk for arrhythmias while undergoing surgical procedures. In this case report, we present a patient with a dual chamber implantable cardioverter-defibrillator who developed intraoperative pacemaker-mediated tachycardia causing significant hemodynamic instability. Management of this arrhythmia can be particularly challenging, because standard application of a magnet does not affect the pacing functions of an implantable cardioverter-defibrillator. Awareness by the anesthesiologist and timely coordination with the cardiac electrophysiology team helped to optimize care for this patient.
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Anesthesia and analgesia · Feb 2013
Marfan's syndrome during pregnancy: anesthetic management of delivery in 16 consecutive patients.
Marfan's syndrome is characterized by progressive dilatation of the aortic root. This dilatation is accelerated by pregnancy, exposing patients to an increased risk of aortic dissection. Literature on the anesthetic management of delivery in patients with Marfan's syndrome consists only of case reports. We therefore conducted a retrospective review of medical records focusing on anesthetic management of delivery in patients with Marfan's syndrome in a national referral center. ⋯ Pregnant women with Marfan's syndrome who received care in a multidisciplinary tertiary care setting that included active peripartum involvement of anesthesiologists had good clinical outcomes.