Anesthesia and analgesia
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Anesthesia and analgesia · May 2016
Randomized Controlled TrialProliposomal Ropivacaine Oil: Pharmacokinetic and Pharmacodynamic Data After Subcutaneous Administration in Volunteers.
Slow-release liposomal formulations of local anesthetics prolong plasma redistribution and reduce peak plasma drug concentration, allowing safer administration of larger doses and further prolonging sensory effects. However, their clinical applicability is limited by expensive manufacture and liposomal leakage. Previously, we described the simple preparation of a novel proliposomal ropivacaine oil that produces multilamellar liposomal vesicles on exposure to aqueous media and that has a shelf-life of >2 years at room temperature. In this study, we present both pharmacodynamic and pharmacokinetic data in healthy volunteers after subcutaneous injection of this novel proliposomal preparation of ropivacaine. ⋯ The prolonged pharmacodynamic effect of proliposomal ropivacaine, together with its delayed elimination and prolonged redistribution to plasma, is compatible to depot-related slow-release and similar to the performance of other liposomal local anesthetics. The advantage of the proliposomal oil is its ease of preparation and its extended shelf-stability at room temperature.
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Anesthesia and analgesia · May 2016
ReviewIs Perioperative Fluid and Salt Balance a Contributing Factor in Postoperative Worsening of Obstructive Sleep Apnea?
An understanding of the potential mechanisms underlying recurrent upper airway collapse may help anesthesiologists better manage patients in the postoperative period. There is convincing evidence in the sleep medicine literature to suggest that a positive fluid and salt balance can worsen upper airway collapse in patients with obstructive sleep apnea through the redistribution of fluid from the legs into the neck and upper airway while supine, in a process known as "rostral fluid shift." According to this theory, during the day the volume from a fluid bolus or from fluid overload states (i.e., heart failure and chronic kidney disease) accumulates in the legs due to gravity, and when a person lies supine at night, the fluid shifts rostrally to the neck, also owing to gravity. ⋯ Similarly, surgical patients also incur large fluid and salt balance shifts, and when recovered supine, this may promote fluid redistribution to the neck and upper airways. In this commentary, we summarize the sleep medicine literature on the impact of fluid and salt balance on obstructive sleep apnea severity and discuss the potential anesthetic implications of excessive fluid and salt volume on worsening sleep apnea.
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Anesthesia and analgesia · May 2016
Randomized Controlled Trial Comparative StudyLow-Fidelity Haptic Simulation Versus Mental Imagery Training for Epidural Anesthesia Technical Achievement in Novice Anesthesiology Residents: A Randomized Comparative Study.
There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in low-fidelity (LF) versus high-fidelity haptic simulation for epidural anesthesia. No study, however, has compared the effect of LF haptic simulation for epidural anesthesia versus mental imagery (MI) training in which no physical practice is attempted. We tested the hypothesis that MI training is superior to LF haptic simulation training for epidural anesthesia skill acquisition. ⋯ MI is not different from LF simulation training for epidural anesthesia skill acquisition. Education in epidural anesthesia with structured didactics and continual MI training may suffice to prepare novice learners before an attempt on human subjects.
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Anesthesia and analgesia · May 2016
In the Aftermath: Attitudes of Anesthesiologists to Supportive Strategies After an Unexpected Intraoperative Patient Death.
Although most anesthesiologists will have 1 catastrophic perioperative event or more during their careers, there has been little research on their attitudes to assistive strategies after the event. There are wide-ranging emotional consequences for anesthesiologists involved in an unexpected intraoperative patient death, particularly if the anesthesiologist made an error. We used a between-groups survey study design to ask whether there are different attitudes to assistive strategies when a hypothetical patient death is caused by a drug error versus not caused by an error. First, we explored attitudes to generalized supportive strategies. Second, we examined our hypothesis that the presence of an error causing the hypothetical patient death would increase the perceived social stigma and self-stigma of help-seeking. Finally, we examined the strategies to assist help-seeking. ⋯ Our participants were more likely to agree with assistive strategies such as not performing further work that day, time off, counseling, formal support strategies, and availability of after-hours counseling services, when the hypothetical patient death from anaphylaxis was due to an error. The perceived stigma toward attending counseling was not affected by the presence or absence of an error as the cause of the patient death, disproving our hypothesis.
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Anesthesia and analgesia · May 2016
Long-Term Outcomes for Different Forms of Stress Cardiomyopathy After Surgical Treatment for Subarachnoid Hemorrhage.
Stress-induced cardiomyopathy (SCM) after subarachnoid hemorrhage (SAH) includes predominant apical or basal regional left ventricular dysfunction (RLVD) with concomitant changes in electrocardiogram or increase in cardiac enzymes. We hypothesized that difference in outcome is associated with the type of RLVD after SAH. ⋯ SAH patients with echocardiogram for a clinically indicated reason have a decreased long-term survival, regardless of the presence of RLVD. The association between severe sepsis and SCM-basal warrants future studies to determine their potential synergistic effect on left ventricular systolic dysfunction among SAH patients.