Anesthesia and analgesia
-
Anesthesia and analgesia · Apr 2014
ReviewExtracorporeal membrane oxygenation in the adult: a review of anticoagulation monitoring and transfusion.
Extracorporeal membrane oxygenation (ECMO) is a method of life support to maintain cardiopulmonary function. Its use as a medical application has increased since its inception to treat multiple conditions including acute respiratory distress syndrome, myocardial ischemia, cardiomyopathy, and septic shock. While complications including neurological and renal injury occur in patients on ECMO, bleeding and coagulopathy are most common. ⋯ In this review article, we discuss the evolution of the various modalities of ECMO, indications, contraindications, and complications. Furthermore, we review the different strategies for anticoagulation and treatment of coagulopathy while on ECMO. Finally, we discuss the cost of ECMO and associated blood product transfusion.
-
Anesthesia and analgesia · Apr 2014
Randomized Controlled Trial Comparative StudyA comparison of posterior and medial cord stimulation for neurostimulation-guided vertical infraclavicular block: a randomized noninferiority clinical trial.
We investigated whether medial cord stimulation is inferior to posterior cord stimulation for vertical infraclavicular block with respect to block success. ⋯ Needle manipulation to elicit medial cord response is noninferior to posterior cord response of block success during neurostimulation-guided vertical infraclavicular block.
-
Anesthesia and analgesia · Apr 2014
Mitigating operating room fires: development of a carbon dioxide fire prevention device.
Operating room fires are sentinel events that present a real danger to surgical patients and occur at least as frequently as wrong-sided surgery. For fire to occur, the 3 points of the fire triad must be present: an oxidizer, an ignition source, and fuel source. The electrosurgical unit (ESU) pencil triggers most operating room fires. ⋯ CO2 3-dimensional spatial mapping suggests effective fire reduction at least 1 cm away from the tip of the ESU pencil at 8 L/min CO2 flow. Future testing should determine optimum CO2 flow rates and ideal nozzle shapes. Use of this device may substantially reduce the risk of patient injury due to operating room fires.
-
Anesthesia and analgesia · Apr 2014
When does apparatus dead space matter for the pediatric patient?
Physiologic dead space is defined as the volume of the lung where gas exchange does not occur. Apparatus dead space increases dead space volume, causing either increased PaCO2 or the need to increase minute ventilation to maintain normocapnia. Children are especially vulnerable because small increases in apparatus dead space can significantly increase dead space to tidal volume ratio (Vd/Vt). ⋯ Similarly, RR required to maintain PaCO2 of 40 mm·Hg increased exponentially with increasing dead space. Increasing apparatus Vd can lead to exponential increases in PaCO2 and/or RR required to maintain normal PaCO2. The effect on PaCO2 is less as patient weight increases, but these data suggest it can be significant for typical circuit components up to at least 17 kg or aged 36 months.
-
Anesthesia and analgesia · Apr 2014
Serum MMP-8 and TIMP-1 in Critically Ill Patients with Acute Respiratory Failure: TIMP-1 Is Associated with Increased 90-Day Mortality.
Matrix metalloproteinases (MMPs) likely have an important role in the pathophysiology of acute lung injury. In a recent study, high matrix metalloproteinases (MMP-8) levels in tracheal aspirates of pediatric acute respiratory distress syndrome (ARDS) patients were associated with worse outcome. In patients with sepsis, an imbalance between MMPs and their tissue inhibitors (TIMPs) has been associated with impaired survival. We hypothesized that the elevated systemic MMP-8 and TIMP-1 are associated with worse outcome in acute respiratory failure. ⋯ MMP-8 levels were possibly higher in 90-day nonsurvivors but performed poorly in predicting outcome. Increased systemic levels of TIMP-1 were associated with more severe hypoxemia and worse outcome in a large cohort of mechanically ventilated critically ill patients and in a subgroup of ARDS patients.