Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2014
Randomized Controlled Trial Multicenter StudyPerioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic Trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery).
Goal directed fluid and vasoactive therapy using a non-invasive cardiac output monitor does not reduce complications after major abdominal surgery.
pearl -
Anesthesia and analgesia · Sep 2014
Multicenter StudyClinical Evaluation of a Novel System for Monitoring Surgical Hemoglobin Loss.
Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, blood lost onto laparotomy sponges during surgical cases was measured using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. In this study, we assessed the accuracy and performance of the system in surgical cases. ⋯ The novel mobile monitoring system provides an accurate measurement of Hb mass on surgical sponges as compared with that of manual rinsing measurements and is significantly more accurate than the gravimetric method. Further study is warranted to assess the clinical use of the technology.
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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
Influence of Provider Type (Nurse Anesthetist or Resident Physician), Staff Assignments, and Other Covariates on Daily Evaluations of Anesthesiologists' Quality of Supervision.
At many U.S. healthcare facilities, supervision of anesthesiology residents and/or Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of anesthesiologists. Our department implemented a daily process by which the supervision provided by each anesthesiologist working in operating rooms was evaluated by the anesthesiology resident(s) and CRNA(s) with whom they worked the previous day. ⋯ Although the attributes that residents and CRNA perceive as constituting "supervision" significantly share commonalities, supervision scores should be analyzed separately for residents and CRNAs. Although mean supervision scores differ markedly among anesthesiologists, supervision scores are influenced negligibly by staff assignments (e.g., how busy the anesthesiologist is with other operating rooms).