Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2015
Reliability and validity of the anesthesiologist supervision instrument when certified registered nurse anesthetists provide scores.
At many facilities in the United States, supervision of Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of anesthesiologists. We use the term "supervision" to include clinical oversight functions directed toward assuring the quality of clinical care whenever the anesthesiologist is not the sole anesthesia care provider. In our department, the supervision provided by each anesthesiologist working in operating rooms is evaluated each day by the CRNA(s) and anesthesiology resident(s) with whom they worked the previous day. The evaluations utilize the 9 questions developed by de Oliveira Filho for residents to assess anesthesiologist supervision. Each question is answered on a 4-point Likert scale (1 = never, 2 = rarely, 3 = frequently, and 4 = always). We evaluated the reliability and validity of the instrument when used in daily practice by CRNAs. ⋯ The de Oliveira Filho supervision instrument was designed for use by residents. Our results show that the instrument also is reliable and valid when used by CRNAs. This is important given our previous finding that the CRNA:MD ratio had no correlation with the level of supervision provided.
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Anesthesia and analgesia · Jan 2015
An electronic checklist improves transfer and retention of critical information at intraoperative handoff of care.
Communication failures are a significant cause of preventable medical errors, and poor-quality handoffs are associated with adverse events. We developed and implemented a simple checklist to improve communication during intraoperative transfer of patient care. ⋯ An electronic checklist improved relay and retention of critical patient information and clinician communication at intraoperative handoff of care.
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Anesthesia and analgesia · Jan 2015
Local Pathology and Systemic Serum Bupivacaine After Subcutaneous Delivery of Slow-Releasing Bupivacaine Microspheres.
Prolonged local anesthesia, particularly desirable to minimize acute and chronic postoperative pain, has been provided by microspheres that slowly release bupivacaine (MS-Bup). In this study, we report on the systemic drug concentrations and the local dermatopathology that occur after subcutaneous injection of MS-Bup. ⋯ Subcutaneous administration of microspheres releasing bupivacaine results in lower blood levels lasting for much longer times than those from bupivacaine solution.
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Anesthesia and analgesia · Jan 2015
Randomized Controlled Trial Comparative StudyNicardipine Is Superior to Esmolol for the Management of Postcraniotomy Emergence Hypertension: A Randomized Open-Label Study.
Emergence hypertension after craniotomy is a well-documented phenomenon for which natural history is poorly understood. Most clinicians attribute this phenomenon to an acute and transient increase in catecholamine release, but other mechanisms such as neurogenic hypertension or activation of the renin-angiotensin-aldosterone system have also been proposed. In this open-label study, we compared the monotherapeutic antihypertensive efficacy of the 2 most titratable drugs used to treat postcraniotomy emergence hypertension: nicardipine and esmolol. We also investigated the effect of preoperative hypertension on postcraniotomy hypertension and the natural history of postcraniotomy hypertension in the early postoperative period. ⋯ Nicardipine is superior to esmolol for the treatment of postcraniotomy emergence hypertension. This type of hypertension is thought to be a transient phenomenon not solely related to sympathetic activation and catecholamine surge but also possibly encompassing other physiologic factors. For treating postcraniotomy emergence hypertension, nicardipine is a relatively effective sole drug, whereas if esmolol is used, rescue antihypertensive medications should be readily available.
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Anesthesia and analgesia · Jan 2015
Are Caudal Blocks for Pain Control Safe in Children? An Analysis of 18,650 Caudal Blocks from the Pediatric Regional Anesthesia Network (PRAN) Database.
The caudal block is the most commonly performed regional anesthesia technique in pediatric patients undergoing surgical procedures, but safety concerns raised by previous reports remain to be addressed. Our main objective in current investigation was to estimate the overall and specific incidence of complications associated with the performance of caudal block in children. ⋯ Safety concerns should not be a barrier to the use of caudal blocks in children assuming an appropriate selection of local anesthetic dosage.