Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2014
Comparative StudyA Comparison of Oxygen Saturation Data in Inpatients with Low Oxygen Saturation Using Automated Continuous Monitoring and Intermittent Manual Data Charting.
The manual collection and charting of traditional vital signs data in inpatient populations have been shown to be inaccurate when compared with true physiologic values. This issue has not been examined with respect to oxygen saturation data despite the increased use of this measurement in systems designed to assess the risk of patient deterioration. Of particular note are the lack of available data examining the accuracy of oxygen saturation charting in a particularly vulnerable group of patients who have prolonged oxygen desaturations (mean SpO2 <90% over at least 15 minutes). In addition, no data are currently available that investigate the often suspected "wake up" effect, resulting from a nurse entering a patient's room to obtain vital signs. ⋯ In a cohort of patients with prolonged desaturations, manual recordings of SpO2 did not reflect physiologic patient state when compared with continuous automated sampling. Currently, early warning scores depend on manual vital sign recordings in many settings; the study data suggest that SpO2 ought to be added to the list of vital sign values that have been shown to be recorded inaccurately.
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Anesthesia and analgesia · Feb 2014
Malignant Hyperthermia in Children: An Analysis of the North American Malignant Hyperthermia Registry.
Clinical characteristics of malignant hyperthermia (MH) in pediatric patients have not been elucidated. In this study, we used the North American Malignant Hyperthermia Registry to determine differences in clinical characteristics of acute MH across pediatric age groups. We hypothesized that there are differences in clinical presentation, clinical course, and outcomes, which correlate with age. A secondary aim was to determine the types of preexisting medical conditions associated with pediatric MH. ⋯ There are differences in clinical characteristics of acute MH among different age cohorts in childhood. Older subjects demonstrated higher body temperatures and higher potassium levels, and the youngest subjects had greater levels of metabolic acidosis. Most children in each age group were phenotypically normal before developing MH.
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Anesthesia and analgesia · Feb 2014
Spinal Cord Stimulation Reduces Mechanical Hyperalgesia and Glial Cell Activation in Animals with Neuropathic Pain.
Spinal cord stimulation (SCS) is commonly used for neuropathic pain; the optimal variables and mechanisms of action are unclear. We tested whether modulation of SCS variables improved analgesia in animals with neuropathic pain by comparing 6-hour vs 30-minute duration and 50%, 75%, or 90% motor threshold (MT) intensity (amplitude). Furthermore, we examined whether maximally effective SCS reduced glial activation in the spinal cord in neuropathic animals. ⋯ Six-hour duration SCS with 90% MT showed the largest increase in mechanical withdrawal threshold, suggesting that the variables of stimulation are important for clinical effectiveness. One potential mechanism for SCS may be to reduce glial activation at the level of the spinal cord.
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Anesthesia and analgesia · Feb 2014
Historical ArticleAlternate methods to teach history of anesthesia.
Residency programs in anesthesiology in the United States struggle to balance the conflicting needs of formal didactic sessions, clinical teaching, and clinical service obligations. As a consequence of the explosion in knowledge about basic and applied sciences related to our specialty, residents and fellows are expected to make substantial efforts to supplement formal lectures with self-study. There is strong evidence to suggest that members of the younger generation use nontraditional methods to acquire information. ⋯ We suggest that informal HOA teaching can be implemented by every residency program without much effort and without taking away from the traditional curriculum. Participating in this unique and enriching experience may be a means of academic advancement. It is our hope and expectation that graduates from programs that incorporate such exposure to HOA become advocates of history and may choose to devote a part of their academic career toward exploration of HOA.