Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2013
ReviewReview article: endotracheal tube cuff leaks: causes, consequences, and management.
The consequences of endotracheal tube (ETT) cuff leak may range from a bubbling noise to a life-threatening ventilatory failure. Although the definitive solution is ETT replacement, this is often neither needed nor safe to perform. Frequently, the leak is not caused by a structural defect in the ETT. ⋯ A risk/benefit analysis of each individual situation is warranted before decisions are made on how best to proceed. Alternative back-up ventilation plans should be preformulated and the necessary equipment ready before the exchange. In this review, various management concerns and plans are discussed, and a simple algorithm to manage leaky ETT cuff situations is presented.
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Anesthesia and analgesia · Aug 2013
Comparative StudyAn ipsilateral comparison of acceleromyography and electromyography during recovery from nondepolarizing neuromuscular block under general anesthesia in humans.
Residual neuromuscular block is defined as a mechanomyography (MMG) or electromyography (EMG) train-of-four (TOF) ratio <0.90, and is common in patients receiving neuromuscular blocking drugs. Objective neuromuscular monitoring is the only reliable way to detect and exclude residual neuromuscular block. Acceleromyography (AMG) is commercially available and easy to use in the clinical setting. However, AMG is not interchangeable with MMG or EMG. Currently, it is unclear what value must be reached by AMG TOF ratio to reliably exclude residual neuromuscular block. ⋯ AMG is less precise than EMG and overestimates EMG TOF ratio by at least 0.15. The lack of agreement cannot be attributed to instrumental imprecision or the baseline difference between successive measurements during spontaneous recovery of neuromuscular function. Residual neuromuscular block cannot be excluded on reaching an AMG TOF ratio of 1.00.
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Anesthesia and analgesia · Aug 2013
Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study.
The use of normal saline is associated with hyperchloremic metabolic acidosis. In this study, we sought to determine the incidence of acute postoperative hyperchloremia (serum chloride >110 mEq/L) and whether this electrolyte disturbance is associated with an increase in length of hospital stay, morbidity, or 30-day postoperative mortality. ⋯ This retrospective cohort trial demonstrates an association between hyperchloremia and poor postoperative outcome. Additional studies are required to demonstrate a causal relationship between these variables.
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Anesthesia and analgesia · Aug 2013
Technical communication: decision support using anesthesia information management system records and accreditation council for graduate medical education case logs for resident operating room assignments.
Our goal in this study was to develop decision support systems for resident operating room (OR) assignments using anesthesia information management system (AIMS) records and Accreditation Council for Graduate Medical Education (ACGME) case logs and evaluate the implementations. We developed 2 Web-based systems: an ACGME case-log visualization tool, and Residents Helping in Navigating OR Scheduling (Rhinos), an interactive system that solicits OR assignment requests from residents and creates resident profiles. Resident profiles are snapshots of the cases and procedures each resident has done and were derived from AIMS records and ACGME case logs. ⋯ Separately, we developed an ACGME case-log visualization tool that allows individual resident experiences to be compared against case minimums as well as resident peer groups. We conclude that it is feasible to use ACGME case-log data in decision support systems for informing resident OR assignments. Additional analysis will be necessary to assess the educational impact of these systems.