Anesthesia and analgesia
-
Anesthesia and analgesia · Jul 2014
National Pediatric Anesthesia Safety Quality Improvement Program in the United States.
As pediatric anesthesia has become safer over the years, it is difficult to quantify these safety advances at any 1 institution. Safety analytics (SA) and quality improvement (QI) are used to study and achieve high levels of safety in nonhealth care industries. We describe the development of a multiinstitutional program in the United States, known as Wake-Up Safe (WUS), to determine the rate of serious adverse events (SAE) in pediatric anesthesia and to apply SA and QI in the pediatric anesthesia departments to decrease the SAE rate. ⋯ WUS documented the incidence and types of SAE nationally in pediatric anesthesiology. Education and application of QI and SA in anesthesia departments are key strategies to improve perioperative safety by WUS.
-
Anesthesia and analgesia · Jul 2014
Wake up safe and root cause analysis: quality improvement in pediatric anesthesia.
In 2006, the Quality and Safety Committee of the Society for Pediatric Anesthesia initiated a quality improvement project for the specialty of pediatric anesthesiology that ultimately resulted in the development of Wake Up Safe (WUS), a patient safety organization that maintains a registry of de-identified, serious adverse events. The ultimate goal of WUS is to implement change in processes of care that improve the quality and safety of anesthetic care provided to pediatric patients nationwide. ⋯ Because institutions across the country use many different RCA methods, WUS educated its members on RCA methods in an effort to standardize the analysis and evaluate each serious adverse event that is submitted. In this review, we summarize the background and development of this patient safety initiative, describe the standardized RCA method used by its members, demonstrate the use of this RCA method to analyze a serious event that was reported, and discuss the ways WUS plans to use the data to promote safer anesthetic practices for children.
-
Anesthesia and analgesia · Jul 2014
Recent Advances in and Limitations of Cardiac Output Monitoring by Means of Electrical Impedance Tomography.
Currently, the monitoring of cardiac output (CO) and stroke volume (SV) is mainly performed using invasive techniques. Therefore, performing CO monitoring noninvasively by means of electrical impedance tomography (EIT) would be advantageous for intensive care. Our hypothesis was that, by means of EIT, it is possible to assess heart rate (HR) and to quantify changes in SV due to changes in ventilator settings. ⋯ The hypothesis that EIT can be used to monitor CO and SV was confirmed, but further studies are required before this technique can be applied in clinical practice. HR was determined robustly and accurately. For SV monitoring, promising results were obtained in 80% of the experiments. However, unexpected scaling of the cardiac EIT signal causing inaccurate estimation of SV remains an issue. Before robust assessment of SV by EIT is suitable for clinical practice, the cause of and compensation for undesired scaling effects need to be investigated.
-
Anesthesia and analgesia · Jul 2014
Abdominal Girth, Vertebral Column Length, and Spread of Spinal Anesthesia in 30 Minutes after Plain Bupivacaine 5 mg/mL.
The spread of spinal anesthesia is highly unpredictable. In patients with increased abdominal girth and short stature, a greater cephalad spread after a fixed amount of subarachnoidally administered plain bupivacaine is often observed. We hypothesized that there is a strong correlation between abdominal girth/vertebral column length and cephalad spread. ⋯ Multiple regression analysis revealed that the combination of a patient's 5 general characteristics, especially abdominal girth and vertebral column length, had a high predictive value for the spread of spinal anesthesia after a given dose of plain bupivacaine.
-
Anesthesia and analgesia · Jul 2014
Phα1β, a Peptide from the Venom of the Spider Phoneutria nigriventer Shows Antinociceptive Effects after Continuous Infusion in a Neuropathic Pain Model in Rats.
Neuropathic pain is a severe painful pathology that is difficult to treat. One option for its management is the continuous intrathecal (i.t.) infusion of ziconotide (the Conus magnus peptide ω-conotoxin MVIIA), which, in addition to being effective, produces serious adverse effects at analgesic doses. Single i.t. administration of Phα1β, a peptide purified from the venom of the spider Phoneutria nigriventer, has antinociceptive effects with a greater therapeutic window than ziconotide in rodents. To further evaluate its analgesic potential, we investigated the antinociceptive and toxic effects of Phα1β after single or continuous i.t. infusion in a rat model of neuropathic pain. ⋯ Thus, we have shown for the first time that the continuous i.t. delivery of Phα1β produces analgesia disconnected from toxicity in a relevant model of neuropathic pain, indicating that it is an effective and safe drug with a great potential to treat pain.