Anesthesia and analgesia
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Intraoperative cell salvage is a strategy to decrease the need for allogeneic blood transfusion. Traditionally, cell salvage has been avoided in the obstetric population because of the perceived risk of amniotic fluid embolism or induction of maternal alloimmunization. ⋯ No definite cases of amniotic fluid embolism have been reported and appear unlikely with modern equipment. Cell salvage is cost-effective in patients with predictably high rates of transfusion, such as parturients with abnormal placentation.
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Anesthesia and analgesia · Aug 2015
Randomized Controlled TrialDexmedetomidine Does Not Affect Evoked Potentials During Spine Surgery.
The effect of dexmedetomidine on evoked potentials (EPs) has not been elucidated. We aimed to investigate the effect of dexmedetomidine on somatosensory, motor, and visual EPs. ⋯ In clinically relevant doses, dexmedetomidine as an adjunct to total IV anesthesia does not seem to alter EPs and therefore can be safely used during surgeries requiring monitoring of EPs.
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Anesthesia and analgesia · Aug 2015
Comparative StudyThe Ability of esCCO™ and ECOM™ Monitors to Measure Trends in Cardiac Output During Alveolar Recruitment Maneuver After Cardiac Surgery: A Comparison with the Pulmonary Thermodilution Method.
Alveolar recruitment maneuvers (ARMs) are known to improve perioperative morbidity but can transiently impact cardiac output (CO). This reproducible hemodynamic perturbation creates a clinical opportunity to test multiple devices during acute changes in CO. The objective of this study was to evaluate the ability of 2 minimally invasive CO monitors, the ECOM (Endotracheal Cardiac Output Monitor) and the esCCO (estimated Continuous Cardiac Output), to measure trends in CO during an ARM in postoperative cardiac surgical patients. ⋯ Compared to pulmonary artery catheter thermodilution, both ECOM and esCCO underestimate changes in CO during an ARM in postoperative cardiac surgical patients. However, ΔECco is within the angular limits of acceptable agreement and may be as efficient as invasive arterial pressure monitoring to track CO changes. In contrast, esCCO is not able to adequately track CO in these specific conditions.
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Anesthesia and analgesia · Aug 2015
Quality of Supervision as an Independent Contributor to an Anesthesiologist's Individual Clinical Value.
Although the clinical (operating room) production of individual anesthesiologists has been measured in multiple related ways (e.g., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by anesthesiologists who are supervising anesthesia residents and nurse anesthetists. The quality of the daily supervision can be measured reliably and validly using the scale developed by de Oliveira Filho et al. If clinical production and supervisory quality were not positively correlated, then it would be important for departments to measure the quality of clinical supervision because, essentially, the clinical value provided by an anesthesiologist would be correlated with, but not necessarily proportional to, their clinical hours. ⋯ When anesthesiologists supervise anesthesia residents and nurse anesthetists, the amount of clinical work performed and the quality of the supervision provided do not necessarily follow one another. Thus, faculty supervision scores serve as an independent measure of the contribution of an individual anesthesiologist to the care of the patient. Furthermore, when supervision quality is monitored and feedback is provided to anesthesiologists, quality can increase. The results suggest that anesthesiology department managers should not only be monitoring (and perhaps reporting) the quality of their departments' level of supervision, but also establishing processes so that individual anesthesiologists can learn about the quality of supervision they provide.
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Anesthesia and analgesia · Aug 2015
Comparative StudyTracking Changes in Cardiac Output: Statistical Considerations on the 4-Quadrant Plot and the Polar Plot Methodology.
When comparing 2 technologies for measuring hemodynamic parameters with regard to their ability to track changes, 2 graphical tools are omnipresent in the literature: the 4-quadrant plot and the polar plot recently proposed by Critchley et al. The polar plot is thought to be the more advanced statistical tool, but care should be taken when it comes to its interpretation. The polar plot excludes possibly important measurements from the data. ⋯ In this article, we compare the 4-quadrant and the polar plot in detail and thoroughly describe advantages and limitations of each. We also discuss pitfalls concerning the methods to prepare the researcher for the sound use of both methods. Finally, we briefly revisit the Bland-Altman plot for the use in this context.