Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2017
Analysis of Hypo- and Hyperphosphatemia in an Intensive Care Unit Cohort.
Blood phosphate levels are vulnerable to fluctuations and changes in phosphate levels are often neglected. The aim of this study was to evaluate whether deviations in phosphate levels correlate to higher 180-day overall mortality or morbidity. ⋯ Phosphate alterations in ICU patients are common and associated with worse morbidity and mortality. Many underlying pathophysiologic mechanisms may play a role. A rapidly changing phosphate level or isolated hypo or hyperphosphatemia should be urgently corrected.
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Anesthesia and analgesia · Jun 2017
Cross-Disciplinary Perceptions of Structured Interprofessional Rounds in Promoting Teamwork Within an Academic Tertiary Care Obstetric Unit.
In 2005, physician and nursing leaders at Brigham and Women's Hospital initiated structured interprofessional rounds (SIPRs) on the labor and delivery (L&D) suite to improve team communication. We performed a cross-sectional analysis of providers' perceptions of SIPRs and their effectiveness in improving teamwork. We hypothesized that on average, providers would perceive SIPRs as being effective in promoting teamwork, but ratings would differ among professional groups. ⋯ On average, providers on the L&D suite perceive SIPRs as being effective in promoting teamwork. Perception ratings were significantly influenced by professional role and number of clinical hours worked weekly, suggesting that these factors should be explored in future research to minimize perception gaps and support a dynamic culture of interprofessional collaboration.
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Anesthesia and analgesia · Jun 2017
Clinical TrialA Novel Way to Secure the Laryngeal Mask Airway During Oral Surgery Procedures.
The laryngeal mask airway (LMA) has been used successfully for an ever-increasing number of applications. Utilization in oral maxillofacial surgery has been hampered by surgical difficulties working around the device. ⋯ LMA-PROP was used with both anesthesia and surgical satisfaction in this small pilot study. LMA-PROP appears to be a helpful new tool allowing the surgeon to maintain current surgical techniques for third molar extraction while securing LMA adequately for anesthesia maintenance.
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Anesthesia and analgesia · Jun 2017
ReviewSubcellular Energetics and Metabolism: A Cross-Species Framework.
Although it is generally believed that oxidative phosphorylation and adequate oxygenation are essential for life, human development occurs in a profoundly hypoxic environment and "normal" levels of oxygen during embryogenesis are even harmful. The ability of embryos not only to survive but also to thrive in such an environment is made possible by adaptations related to metabolic pathways. ⋯ Many biological states, both normal and pathological, share underlying similarities related to metabolism, the electron transport chain, and reactive species. The purpose of Part I of this review is to review the similarities among embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, with a particular focus on the common characteristics that allow cells and organisms to survive in these states.
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Anesthesia and analgesia · Jun 2017
Comparative StudyAnalgesic Choice in Management of Rib Fractures: Paravertebral Block or Epidural Analgesia?
Rib fractures are commonly encountered in the setting of trauma. The aim of this study was to assess the association between the clinical outcome of rib fracture and epidural analgesia (EA) versus paravertebral block (PVB) using the National Trauma Data Bank (NTDB). ⋯ Using the NTDB, EA and PVB were not found to be significantly different in management of rib fractures. There was an association between use of a block and improved outcome, but this could be explained by selection of healthier patients to receive a block. Prospective study of this association is recommended.