Anesthesia and analgesia
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Anesthesia and analgesia · May 2016
Work Habits Are Valid Components of Evaluations of Anesthesia Residents Based on Faculty Anesthesiologists' Daily Written Comments About Residents.
In our department, faculty anesthesiologists routinely evaluate the resident physicians with whom they worked in an operative setting the day before, providing numerical scores to questions. The faculty can also enter a written comment if so desired. Because residents' work habits are important to anesthesiology program directors, and work habits can improve with feedback, we hypothesized that faculty comments would include the theme of the anesthesia resident's work habits. ⋯ Although faculty anesthesiologists completed (numerical) questions based on the American College of Graduate Medical Education competencies to evaluate residents, an important percentage of written comments included the theme of work habits. The implication is that the theme has validity as one component of the routine evaluation of anesthesia residents.
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Anesthesia and analgesia · May 2016
The Sounds of Desaturation: A Survey of Commercial Pulse Oximeter Sonifications.
The pulse oximeter has been a standard of care medical monitor for >25 years. Most manufacturers include a variable-pitch pulse tone in their pulse oximeters. Research has shown that the acoustic properties of variable-pitch tones are not standardized. In this study, we surveyed the properties of pulse tones from 21 pulse oximeters, consisting of 1 to 4 instruments of 11 different models and 8 brands. Our goals were to fully document the sounds over saturation values 0% to 100%, test whether tones become quieter at low saturation values, and create a public repository of pulse oximeter recordings for future use. ⋯ Current pulse oximeters use different techniques to address the competing goals of (1) using pitch steps that are large enough to be readily perceived, and (2) conveying saturation values from 0 to 100 within a limited range of sound frequencies. From a clinical perspective, 2 techniques for increasing perceivability (increasing the frequency range and using ratio step sizes) have no drawback, but 2 techniques (not changing pitch at every saturation change and using a lower saturation cutoff) do have potential clinical drawbacks. On the basis of our findings, we have made suggestions for clinicians and manufacturers.
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Anesthesia and analgesia · May 2016
The Effects of the Toll-Like Receptor 4 Antagonist, Ibudilast, on Sevoflurane's Minimum Alveolar Concentration and the Delayed Remifentanil-Induced Increase in the Minimum Alveolar Concentration in Rats.
Ultralow doses of naloxone, an opioid and toll-like receptor 4 antagonist, blocked remifentanil-induced hyperalgesia and the associated increase in the minimum alveolar concentration (MAC), but not tolerance. The aim was to determine the effects of the toll-like receptor 4 antagonist, ibudilast, on the MAC in the rat and how it might prevent the effects of remifentanil. ⋯ Ibudilast, besides reducing the MAC, prevented the delayed increase in baseline MAC produced by remifentanil but not the increase in MAC caused by tolerance to remifentanil.
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Anesthesia and analgesia · May 2016
Electroacupuncture Enhances the Antiallodynic and Antihyperalgesic Effects of Milnacipran in Neuropathic Rats.
Milnacipran, a selective serotonin/norepinephrine-reuptake inhibitor, has been shown to elicit a beneficial effect in various models of neuropathic pain. Previously, we reported that repetitive electroacupuncture (EA) significantly ameliorates neuropathic pain induced by L5 spinal nerve ligation (SNL). In the present study, we sought to determine whether a single treatment with EA produces analgesia and whether EA in combination with a subeffective dosage of milnacipran exhibits an additive effect in SNL rats. ⋯ The study shows that, in male rats with SNL, spinal administration of milnacipran effectively alleviates mechanical allodynia and thermal hyperalgesia, and that a single treatment of EA has an antihyperalgesic effect. Furthermore, our findings suggest that coapplication of EA and milnacipran enhanced antiallodynia and antihyperalgesia by activating spinal noradrenergic systems coupled with spinal α2-adrenoceptors and prolongs the duration of analgesia.