Anesthesia and analgesia
-
Anesthesia and analgesia · Aug 2013
Comparative StudyThe cytotoxicity of bupivacaine, ropivacaine, and mepivacaine on human chondrocytes and cartilage.
Intraarticular injections of local anesthetics are frequently used as part of multimodal pain regimens. However, recent data suggest that local anesthetics affect chondrocyte viability. In this study, we assessed the chondrotoxic effects of mepivacaine, ropivacaine, and bupivacaine. We hypothesized that specific cytotoxic potencies directly correlate with analgesic potencies, and that cytotoxic effects in intact cartilage are different than in osteoarthritic tissue. ⋯ Bupivacaine, ropivacaine, and mepivacaine are chondrotoxic in a time-dependent, concentration-dependent, and drug-dependent manner. Chondrotoxic and analgesic potencies do not directly correlate. Cellular death rates were higher in osteoarthritic compared with intact cartilage after local anesthetic treatment.
-
Anesthesia and analgesia · Aug 2013
Randomized Controlled Trial WebcastsPatient warming excess heat: the effects on orthopedic operating room ventilation performance.
Patient warming has become a standard of care for the prevention of unintentional hypothermia based on benefits established in general surgery. However, these benefits may not fully translate to contamination-sensitive surgery (i.e., implants), because patient warming devices release excess heat that may disrupt the intended ceiling-to-floor ventilation airflows and expose the surgical site to added contamination. Therefore, we studied the effects of 2 popular patient warming technologies, forced air and conductive fabric, versus control conditions on ventilation performance in an orthopedic operating room with a mannequin draped for total knee replacement. ⋯ Excess heat from forced air warming resulted in the disruption of ventilation airflows over the surgical site, whereas conductive patient warming devices had no noticeable effect on ventilation airflows. These findings warrant future research into the effects of forced air warming excess heat on clinical outcomes during contamination-sensitive surgery.
-
Anesthesia and analgesia · Aug 2013
Noninvasive continuous cardiac output by the nexfin before and after preload-modifying maneuvers: a comparison with intermittent thermodilution cardiac output.
The Nexfin uses an uncalibrated pulse contour method for the continuous measurement of cardiac output (CO) in a totally noninvasive manner. Since the accuracy of pulse contour methods and their ability to track changes in CO have been repeatedly questioned, we have compared the CO measured by the Nexfin (NAPCO) with the CO measured by the pulmonary artery catheter (PACCO) in cardiosurgical patients before and after preload-modifying maneuvers. ⋯ Although the Nexfin has limited accuracy when compared with the pulmonary artery catheter, it can reliably track preload-induced changes in CO in stable patients after cardiac surgery in the presence of moderate vasopressor and inotropic therapy. This ability, combined with its total noninvasiveness, fast installation, and ease of use, make the Nexfin a suitable monitor for the perioperative continuous measurement of CO. The reliability of this monitor in tracking the CO when significant changes in peripheral resistance take place still needs to be established.
-
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.
-
Anesthesia and analgesia · Aug 2013
What Is the Accuracy of the High-Fidelity METI Human Patient Simulator Physiological Models During Oxygen Administration and Apnea Maneuvers?
A widely used physiological simulator is generally accepted to give valid predictions of oxygenation status during disturbances in breathing associated with anesthesia. We compared predicted measures with physiological measurements available in the literature, or derived from other models. ⋯ Spo2 decreased much later during apnea on the METI simulator than in a clinical situation, whether preoxygenation was performed or not. The debriefing after simulation of critical situations or the use of the METI simulator to test a new equipment must consider these results.