Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2014
Comparative StudyAn Evaluation of a Zero-Heat-Flux Cutaneous Thermometer in Cardiac Surgical Patients.
Although core temperature can be measured invasively, there are currently no widely available, reliable, noninvasive thermometers for its measurement. We thus compared a prototype zero-heat-flux thermometer with simultaneous measurements from a pulmonary artery catheter. Specifically, we tested the hypothesis that zero-heat-flux temperatures are sufficiently accurate for routine clinical use. ⋯ Core temperature can be noninvasively measured using the zero-heat-flux method. Bias was small, but precision was slightly worse than our designated 0.5°C limits compared with measurements from a pulmonary artery catheter.
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Anesthesia and analgesia · Sep 2014
ReviewNeurodevelopmental assessment after anesthesia in childhood: review of the literature and recommendations.
Preclinical studies have established that anesthesia is toxic to the brain in neonatal animals, but scant research investigates the neurodevelopmental effects of exposure to anesthesia. In this article, we discuss the issue of outcome measurement of children after anesthesia administered between infancy and approximately 4 years of age. ⋯ The strengths and limitations of this literature is reviewed, followed by a discussion of how future trials investigating neurodevelopmental outcome after anesthesia might be improved by procedures designed specifically to assess the status of the central nervous system. Neuropsychological assessment is described and proposed as a way to increase the validity and sensitivity of forthcoming studies that intend to evaluate the short- and long-term effects of exposure to anesthesia during infancy and early childhood.
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Anesthesia and analgesia · Sep 2014
Positive end-expiratory pressure to increase internal jugular vein size is poorly tolerated in obese anesthetized adults.
Central venous cannulation is technically challenging in obese patients. We hypothesized that positive end-expiratory pressure (PEEP) increases the size of the internal jugular vein (IJV) in obese adults. ⋯ PEEP modestly increases the size of the IJV in obese adults but was poorly tolerated because of hypotension.
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Anesthesia and analgesia · Sep 2014
Bernoulli Cumulative Sum (CUSUM) Control Charts for Monitoring of Anesthesiologists' Performance in Supervising Anesthesia Residents and Nurse Anesthetists.
We describe our experiences in using Bernoulli cumulative sum (CUSUM) control charts for monitoring clinician performance. The supervision provided by each anesthesiologist is evaluated daily by the Certified Registered Nurse Anesthetists (CRNAs) and/or anesthesia residents with whom they work. Each of 9 items is evaluated (1 = never, 2 = rarely, 3 = frequently, 4 = always). ⋯ For example, when an evaluation of an anesthesiologist 1 day by a CRNA had a low score, there was an increased chance that another CRNA working in a different operating room on the same day would also give that same anesthesiologist a low score (P < 0.0001). This correlation among scores does affect the Bernoulli CUSUM, such that detection is more likely. This is an advantage for our continual process improvement application since it flags individuals for further evaluation by managers while maintaining confidentiality of raters.
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Anesthesia and analgesia · Sep 2014
Editorial CommentThe growing burden of perioperative heart failure.