Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2017
Observational StudyLung Ultrasonography for the Assessment of Perioperative Atelectasis: A Pilot Feasibility Study.
Few diagnostic tools are available to anesthesiologists when confronted with intraoperative hypoxemia. Lung ultrasonography is a safe and accurate bedside imaging modality. The aim of this study was to evaluate the feasibility of lung ultrasonography during the perioperative period and assess its ability to detect intraoperative respiratory complications and oxygenation changes resulting from perioperative atelectasis. ⋯ Lung ultrasonography in the perioperative period is feasible, allows tracking of perioperative atelectasis, and facilitates the diagnosis of respiratory complications. The evolution of aeration loss correlates moderately with changes in oxygenation.
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Anesthesia and analgesia · Feb 2017
Comparative StudyImpact of Systemic Vascular Resistance on the Accuracy of the Pulsioflex Device.
The accuracy of currently available devices using pulse contour analysis without external calibration for cardiac index (CI) estimation is negatively impacted by hyperdynamic states, low systemic vascular resistance (SVR), and abrupt changes in SVR. The aim of this study was to evaluate the accuracy of a new device, the Pulsioflex (Pulsion Medical System), in patients undergoing liver transplantation. ⋯ In patients undergoing liver transplantation, Pulsioflex does not accurately estimate CI. Its accuracy is highly impacted by SVR, and it is not able to track changes in CI when large variations in SVR occur.
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Anesthesia and analgesia · Feb 2017
Observational StudyRelationship Between Preoperative Evaluation Blood Pressure and Preinduction Blood Pressure: A Cohort Study in Patients Undergoing General Anesthesia.
For outcomes research where changes in intraoperative blood pressure are a possible causative factor, it is important to determine an appropriate source for a reference value. We studied to what extent preinduction blood pressure values in the operating room differ from those obtained during preoperative evaluation outside the operating room. ⋯ The average preinduction blood pressure was higher than the preoperative blood pressure. This difference between the measurements can be explained by stress-induced effects and regression to the mean. To define an optimal reference value for research purposes or to arrive at a clinical perioperative blood pressure target, one should consider that there is important variability both within and between patients.
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Anesthesia and analgesia · Feb 2017
Sedation of Patients With Disorders of Consciousness During Neuroimaging: Effects on Resting State Functional Brain Connectivity.
To reduce head movement during resting state functional magnetic resonance imaging, post-coma patients with disorders of consciousness (DOC) are frequently sedated with propofol. However, little is known about the effects of this sedation on the brain connectivity patterns in the damaged brain essential for differential diagnosis. In this study, we aimed to assess these effects. ⋯ Our findings indicate that connectivity decreases associated with propofol sedation, involving the thalamus and insula, are relatively small compared with those already caused by DOC-associated structural brain injury. Nonetheless, given the known importance of the thalamus in brain arousal, its disruption could well reflect the diminished movement obtained in these patients. However, more research is needed on this topic to fully address the research question.
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Anesthesia and analgesia · Feb 2017
Implementation of a Needs-Based, Online Feedback Tool for Anesthesia Residents With Subsequent Mapping of the Feedback to the ACGME Milestones.
Optimizing feedback that residents receive from faculty is important for learning. The goals of this study were to (1) conduct focus groups of anesthesia residents to define what constitutes optimal feedback; (2) develop, test, and implement a web-based feedback tool; and (3) then map the contents of the written comments collected on the feedback tool to the Accreditation Council for Graduate Medical Education (ACGME) anesthesiology milestones. ⋯ Resident focus groups recommended that feedback be timely and specific and be structured around a tool. A customized online feedback tool was developed and implemented. Mapping of the free-text feedback comments may assist in assessing milestones. Use of the feedback tool was lower than expected, which may indicate that it is just 1 of many implementation steps required for behavioral and culture change to support a learning environment with frequent and useful feedback.