Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2013
ReviewReview article: heparin sensitivity and resistance: management during cardiopulmonary bypass.
Heparin resistance during cardiac surgery is defined as the inability of an adequate heparin dose to increase the activated clotting time (ACT) to the desired level. Failure to attain the target ACT raises concerns that the patient is not fully anticoagulated and initiating cardiopulmonary bypass may result in excessive activation of the hemostatic system. Although antithrombin deficiency has generally been thought to be the primary mechanism of heparin resistance, the reasons for heparin resistance are both complex and multifactorial. ⋯ Nevertheless, many clinicians choose a target ACT to assess anticoagulation, and interventions aimed at achieving the target ACT are routinely performed in the setting of heparin resistance. Treatments for heparin resistance/alterations in heparin responsiveness include additional heparin or antithrombin supplementation. In this review, we discuss the variability of heparin potency, heparin responsiveness as measured by the ACT, and the current management of heparin resistance.
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Anesthesia and analgesia · Jun 2013
A behavioral study of daily mean turnover times and first case of the day start tardiness.
Previous research has identified 2 psychological biases in operating room (OR) decisions on the day of surgery: risk attitude of the decision-maker at the OR control desk and decisions made by OR staff to increase clinical work per unit time during the hours they are assigned. Resulting decisions are worse than random chance at reducing overutilized time. To isolate the second bias from decisions at the OR control desk, previous studies of the second bias have analyzed decisions made in non-OR locations and on nights/weekends. Another way to isolate the second bias from decisions at the OR control desk is to study facilities with negligible overutilized OR time. We examined the second bias using data from such a facility. ⋯ Previous experimental and observational studies found many clinicians maintained high clinical work per unit time during the hours to which they were assigned. We tested and confirmed a prediction of this bias as was applied during regularly scheduled OR hours among an entire surgical team. Overall, the staff worked just as quickly on days with few or many hours of cases. The OR staff did not slow down, thus filling the time. These results have important implications for the cost utility of information technologies to facilitate managerial decision-making on the day of surgery.
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Anesthesia and analgesia · Jun 2013
The protective effects of volatile anesthestics against the bronchoconstriction induced by an allergic reaction in sensitized rabbit pups.
Volatile inhaled anesthetics exert a differential protective effect against bronchospasm development after cholinergic stimulation. However, their ability to inhibit the adverse respiratory consequences of an anaphylactic reaction after exposure to an allergen has not been characterized. We therefore compared the abilities of isoflurane, sevoflurane, and desflurane to prevent the lung constriction induced by an allergic reaction in a pediatric model of an anaphylactic reaction. ⋯ Our results reveal the lack of potential of the commonly used volatile anesthetics to inhibit the most severe acute phase of the constrictor response to allergen after anaphylaxis in both the central airway and peripheral lung compartments. Inhalation of volatile anesthetics, particularly sevoflurane, promotes an earlier easing of the bronchospasm; this beneficial profile may be advantageous in children with atopic lung diseases.
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Anesthesia and analgesia · Jun 2013
Determinants, associations, and psychometric properties of resident assessments of anesthesiologist operating room supervision.
A study by de Oliveira Filho et al. reported a validated set of 9 questions by which Brazilian anesthesia residents assessed faculty supervision in the operating room. The aim of this study was to use this question set to determine whether faculty operating room supervision scores were associated with residents' year of clinical anesthesia training and/or number of specific resident-faculty interactions. We also characterized associations between faculty operating room supervision scores and resident assessments of: (1) faculty supervision in settings other than operating rooms, (2) faculty clinical ability (family choice), and (3) faculty teaching effectiveness. Finally, we characterized the psychometric properties of the de Oliveira Filho etal. question set in an United States anesthesia residency program. ⋯ Supervision scores provided by all residents can be given equal weight when calculating an individual faculty anesthesiologist's mean supervision score. Assessments of supervision, teaching, and quality of clinical care are highly correlated. When the de Oliveira Filho et al. question set is used in a United States anesthesia residency program, supervision scores are highly reliable and dependable when at least 15 residents assess each faculty.
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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.