Anesthesia and analgesia
-
Anesthesia and analgesia · Jun 2015
Comparative StudyA comparison of plaintiff and defense expert witness qualifications in malpractice litigation in anesthesiology.
Expert witnesses serve a crucial role in the medicolegal system, interpreting evidence so that it can be understood by jurors. Guidelines have been established by both the legal community and professional medical societies detailing the expectations of expert witnesses. The primary objective of this analysis was to evaluate the expertise of anesthesiologists testifying as expert witnesses in malpractice litigation. ⋯ Anesthesiologists testifying for both sides are very experienced. Defense expert witnesses are more likely to have a higher scholarly impact and to practice in an academic setting. This indicates that defense expert witnesses may have greater expertise than plaintiff expert witnesses.
-
Anesthesia and analgesia · Jun 2015
The relevance of pupillometry for evaluation of analgesia before noxious procedures in the intensive care unit.
Many patients in the intensive care unit are unable to communicate verbally. Accurately predicting whether such patients will exhibit painful behaviors during noxious procedures and assessing the adequacy of analgesia during those procedures is a challenge. In addition to observational pain assessment tools such as the Behavioral Pain Scale, physiologic indicators such as the pupillary response have been proposed. The pupil is innervated by both divisions of the autonomic nervous system and is affected by pain and analgesic medications. We evaluated the pupillary response to a light stimulus before noxious procedures as a method to predict pain during the procedure. ⋯ In patients unable to communicate verbally, pupillometry may potentially guide caregivers to adjust analgesia before noxious procedures.
-
Because anesthetic machines have become more complex and more expensive, they have become less suitable for use in the many isolated hospitals in the poorest countries in the world. In these situations, they are frequently unable to function at all because of interruptions in the supply of oxygen or electricity and the absence of skilled technicians for maintenance and servicing. Despite these disadvantages, these machines are still delivered in large numbers, thereby expending precious resources without any benefit to patients. ⋯ Additional economies are achieved by completely eliminating spillage of oxygen from the breathing system and by recycling the driving gas into the breathing system to increase the Fraction of Inspired Oxygen (FIO2) at no extra cost. Savings also are accrued when using the drawover breathing system as the need for nitrous oxide, compressed air, and soda lime are eliminated. The Glostavent enables the administration of safe anesthesia to be continued when standard machines are unable to function and can do so with minimal harm to the environment.