Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2013
Color flow Doppler ultrasonography can distinguish caudal epidural injection from intrathecal injection.
Color flow Doppler ultrasonography has been used to confirm caudal epidural injection, but its ability to detect accidental intrathecal injection is unknown. We hypothesized that, when using color flow Doppler, the injection of fluid into the epidural space would result in turbulent flow which would appear as a burst of color while intrathecal injection would show an absence of a color flow Doppler signal. ⋯ In the context of this study, color flow Doppler could differentiate epidural from intrathecal injection into the caudal space of children up to 6 years of age using a 0.1 mL/kg injection volume and injection rate of 0.5 to 1.0 mL/s.
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Anesthesia and analgesia · Jun 2013
The influence of antithrombin substitution on heparin sensitivity and activation of hemostasis during coronary artery bypass graft surgery: a dose-finding study.
Cardiopulmonary bypass is associated with a high degree of hemostatic system activation. Supplementation of antithrombin (AT) may attenuate this activation and increase a patient's susceptibility to heparin. However, the appropriate dosage of AT has not been defined. We sought to determine the dosage of AT concentrate necessary to achieve >100% AT activity at the end of cardiac surgery and the influence of AT on heparin sensitivity. ⋯ High dosages of AT were required to preserve physiologic AT activity during coronary artery bypass graft surgery and to significantly enhance heparin sensitivity, respectively. However, a significant decrease in AT activity, accompanied by high levels of thrombin generation, was encountered up to 5 days postoperatively.
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Anesthesia and analgesia · Jun 2013
Anesthesiology residents' and nurse anesthetists' perceptions of effective clinical faculty supervision by anesthesiologists.
Often anesthesia care is provided by nonfaculty anesthesia providers (e.g., anesthesiology residents and certified registered nurse anesthetists [CRNAs]) under the guidance of faculty anesthesiologists. Performance appraisal of faculty anesthesiologists should therefore include evaluation of this guidance. ⋯ Most CRNAs and residents at 3 teaching hospitals considered faculty guidance that meets expectations to be at least "frequent," regardless of years in practice.
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Anesthesia and analgesia · Jun 2013
Intrathecal pain pump infusions for intractable cancer pain: an algorithm for dosing without a neuraxial trial.
Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an intrathecal pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial intrathecal pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay. ⋯ When an epidural trial is not feasible and an intrathecal pump is required in a cancer patient, it is possible to predict an initial dose for the intrathecal pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home.
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Anesthesia and analgesia · Jun 2013
Case Reports"Stay, give me your paw." The benefits of family-centered care.
The value of family-centered care in general and subspecialty pediatrics has been well documented in the literature. Translation of these principles into perioperative medicine has its logistical challenges; however, there are theoretical benefits. ⋯ We describe the presence of one such service dog, at the request of our patient, during induction of general anesthesia. Consideration of the service dog as part of our family-centered care model improved the quality of care we provided this anxious teenager and her mother.