Anesthesia and analgesia
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The nasopharynx is considered 1 of the 4 generally reliable core temperature measurement sites. But curiously, there is no consensus on how far past the nares to insert the probe. Insertion depth is likely to influence the accuracy of nasopharyngeal temperature measurements because probes near the nares will be cooled by ambient air; similarly, probes inserted too far may approach the airway and be cooled by ventilation gases. We thus determined the range of nasopharyngeal probe insertion depths that best approximate reference core temperature measured in the distal esophagus. ⋯ Any nasopharyngeal probe insertion depth between 10 and 20 cm well represents core temperature in adults having noncardiac surgery.
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Despite mixed results regarding the clinical utility of checklists, the anesthesia community is increasingly interested in advancing research around this important topic. Although several checklists have been developed to address routine perioperative care, few checklists in the anesthesia literature specifically target the management of trauma patients. We adapted a recently published "trauma and emergency checklist" for the initial phase of resuscitation and anesthesia of critically ill trauma patients into an applicable perioperative cognitive aid in the form of a pictogram that can be downloaded by the medical community. ⋯ A brief online survey is also presented to obtain feedback for improvement of this tool. The variability in utility of cognitive aids may be because of the specific clinical task being performed, the skill level of the individuals using the cognitive aid, overall quality of the cognitive aid, or organizational challenges. Once optimized, future research should be focused at ensuring successful implementation and customization of this tool.
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Anesthesia and analgesia · May 2016
Comparative StudyThe Effects of Lidocaine on Central Respiratory Neuron Activity and Nociceptive-Related Responses in the Brainstem-Spinal Cord Preparation of the Newborn Rat.
Lidocaine is widely used in the clinical setting as a local anesthetic and antiarrhythmic drug. Although it has been suggested that lidocaine exerts inhibitory effects on the central and peripheral neurons, there are no reports on its effects on central respiratory activity in vertebrates. In this study, we examined the effects of lidocaine on respiratory rhythm generation and nociceptive response in brainstem-spinal cord preparations from the newborn rats. ⋯ Our findings indicate that lidocaine depressed nociception-related responses at lower concentrations than those that induced respiratory depression. Our report provides the basic neuronal mechanisms to support the clinical use of lidocaine, which shows antinociceptive effects with minimal side effects on breathing.