Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
Technical communication: the effect of the double mask on anesthetic waste gas levels during pediatric mask inductions in dental offices.
A significant portion of office-based general anesthesia for pediatric patients is performed in dental offices and involves mask inductions with inhaled drugs. This can lead to significant pollution with waste gases. ⋯ Levels of sevoflurane decreased from a median of 4.60 ppm (IQR = 3.10-7.00 ppm, n = 9) to 0 ppm (IQR = 0-0.39 ppm, n = 9, P = 0.0024) and exceeded 2 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. We demonstrated in our study that the double-mask system, when used with dental "high-volumes" suctions (high-volume evacuators producing approximately 12 m(3)/h) in freestanding dental offices, was sufficient to decrease the exposure to anesthetic waste gas during pediatric mask induction in at least two thirds of offices when compared with the traditional mask.
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Anesthesia and analgesia · Jul 2013
Research, education, and nonclinical service productivity of new junior anesthesia faculty during a 2-year faculty development program.
As a specialty, anesthesiology has relatively low research productivity. Prior studies indicate that junior faculty development programs favorably affect academic performance. We therefore initiated a junior faculty development program and hypothesized that most (>50%) new junior faculty would take <50 nonclinical days to achieve a primary program goal (e.g., investigation or publication), and <5 nonclinical days to achieve a secondary program goal (e.g., teaching or nonclinical service). ⋯ Even with structured developmental support, most new junior anesthesia faculty needed >50 nonclinical days to achieve a primary (traditional academic) goal and >5 nonclinical days to achieve a secondary goal. Currently, most new anesthesia faculty are not productive in traditional academic activities (research). They are more productive in activities related to clinical care, education, and patient care systems management.
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Anesthesia and analgesia · Jul 2013
Case ReportsCase report: anterior mediastinal central line malposition.
Central venous catheter (CVC) placement is a routine procedure in the management of critically ill patients. It is important to ensure correct positioning of the catheter tip just above the junction of the superior vena cava and the right atrium, to reduce associated complications and to optimize catheter function. The incidence of catheter misplacement is approximately 3%-4% for both subclavian and internal jugular vein access procedures. CVC placement in the right subclavian vein is associated with a higher risk of malposition.(1) We report an unexpected secondary malposition of a right subclavian CVC in the anterior mediastinum, with resultant vena caval perforation in a patient admitted to the neuro-critical care unit after undergoing a craniotomy procedure.
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Anesthesia and analgesia · Jul 2013
Special article: airway management in reconstructive surgery for noma (cancrum oris).
Noma (cancrum oris) is a disease of poverty and malnutrition, which predominantly affects children younger than 10 years in developing countries. Although the majority of sufferers die of sepsis at the time of the initial infection, or of subsequent starvation due to severe trismus and an inability to eat, a small minority of patients survive and require reconstructive surgery for severe facial scarring and deformity. ⋯ We show that airway management, while challenging, can be performed safely and successfully by using individualized airway plans but may require advanced techniques and equipment. Traditional tests focusing on the anterior/superior airway are helpful in assessing patients with facial deformity due to noma.
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Dexmedetomidine has become a popular sedative in the intensive care unit for patients undergoing mechanical ventilation because of its highly selective α-2 agonism, which exerts a combination of anesthetic, analgesic, and anxiolytic effects. Bradycardia and hypotension have been reported as the most common side effects of its use in large studies. Dexmedetomidine has been reported to induce polyuria by suppressing vasopressin secretion and increasing permeability of the collecting ducts in a dose-dependent fashion. We report a case of dexmedetomidine-related polyuria that occurred with a high-dose continuous infusion and subsequently resolved with discontinuation of the drug. (Anesth Analg 2013;117:150-2).