Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2015
ReviewE-mail as the Appropriate Method of Communication for the Decision-Maker When Soliciting Advice for an Intellective Decision Task.
For many problems in operating room and anesthesia group management, there are tasks with optimal decisions, and yet experienced personnel tend to make decisions that are worse or no better than random chance. Such decisions include staff scheduling, case scheduling, moving cases among operating rooms, and choosing patient arrival times. In such settings, operating room management leadership decision-making should typically be autocratic rather than participative. ⋯ Given that the manager is e-mailing an advisor whose competence the manager trusts, it is unnecessary to use a richer communication channel to develop trust. Finally, many of the limitations of e-mail can be rectified through training. We expect that decades from now, e-mail (i.e., asynchronous writing) between an expert and decision-maker will remain the dominant means of communication for intellective tasks.
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Anesthesia and analgesia · Sep 2015
Balancing Model Performance and Simplicity to Predict Postoperative Primary Care Blood Pressure Elevation.
Because of uncertainty regarding the reliability of perioperative blood pressures and traditional notions downplaying the role of anesthesiologists in longitudinal patient care, there is no consensus for anesthesiologists to recommend postoperative primary care blood pressure follow-up for patients presenting for surgery with an increased blood pressure. The decision of whom to refer should ideally be based on a predictive model that balances performance with ease-of-use. If an acceptable decision rule was developed, a new practice paradigm integrating the surgical encounter into broader public health efforts could be tested, with the goal of reducing long-term morbidity from hypertension among surgical patients. ⋯ In a national cohort of surgical patients, poorly controlled postoperative clinic blood pressure was present in >1 of 4 patients (95% CI, 25.5%-25.9%). Predictive modeling based on the mean of 2 preoperative blood pressure measurements performed nearly as well as more complicated models and may provide acceptable predictive performance to guide postoperative referral decisions. Future studies of the feasibility and efficacy of such referrals are needed to assess possible beneficial effects on long-term cardiovascular morbidity.
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Anesthesia and analgesia · Sep 2015
Initial Preference for Labor Without Neuraxial Analgesia and Actual Use: Results from a National Survey in France.
The rate of neuraxial analgesia during labor in France is one of the highest among high-income countries: 77% of vaginal deliveries in 2010. In this context, the question of how women's preferences for delivering without neuraxial analgesia relate to actual use is of interest. Our objective was to study the factors associated with women's initial preference for labor without neuraxial analgesia and those associated with its use in women who initially preferred not to have it. ⋯ Our results suggest that parity, the management of labor, and availability of anesthesiologists play a major role in the intrapartum decision to use neuraxial analgesia for women who initially preferred not to have it. Further research is necessary in the clinical circumstances leading to this decision and the role of women's demands and medical staff attitudes throughout labor.
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Anesthesia and analgesia · Sep 2015
The Feasibility of Simultaneous Orthogonal Plane Imaging with Tilt for Short-Axis Evaluation of the Pulmonic Valve by Transesophageal Echocardiography.
Simultaneous orthogonal plane imaging with tilt enables the display of two 2D, real-time images and the evaluation of structures that cannot be seen by conventional single-plane transesophageal echocardiographic (TEE) imaging. After a step-wise examination protocol, we used simultaneous orthogonal plane imaging to obtain the short-axis view of the pulmonic valve (PV) and assessed flow in both images simultaneously using color Doppler imaging in 100 consecutive patients undergoing intraoperative TEE. Our goals were to assess the ability of this technique to visualize all 3 leaflets of the PV, assess feasibility of planimetry to measure valve area, and assess flow using color Doppler imaging. ⋯ Planimetry for valve area was possible when all 3 leaflets were seen. It is important to inspect the PV during a routine TEE examination; however, the orientation of the PV in respect to the esophagus makes this evaluation challenging. We present a simple protocol to evaluate the PV in long-axis and short-axis views simultaneously that can potentially help evaluate for pathologies involving the PV.
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Anesthesia and analgesia · Sep 2015
The Analgesic Effect of Rolipram, a Phosphodiesterase 4 Inhibitor, on Chemotherapy-Induced Neuropathic Pain in Rats.
Chemotherapy-induced neuropathic pain is a significant side effect of chemotherapeutic agents. Currently, there are no effective analgesics for chemotherapy-induced neuropathic pain. Rolipram is a selective phosphodiesterase 4 inhibitor, which increases intracellular cyclic AMP in nerve and immune cells. The aim of our study was to determine the analgesic effects of rolipram on paclitaxel (PAC)-induced neuropathic pain in rats. ⋯ These results suggest that rolipram alleviated mechanical allodynia induced by PAC in rats. Thus, phosphodiesterase 4 inhibitors may prove useful in the treatment of chemotherapy-induced neuropathic pain. However, further studies are needed to clarify their effects in clinical settings.