Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2017
Randomized Controlled Trial Multicenter StudyOptimization of Endotracheal Tube Cuff Pressure by Monitoring CO2 Levels in the Subglottic Space in Mechanically Ventilated Patients: A Randomized Controlled Trial.
Many of the complications of mechanical ventilation are related to inappropriate endotracheal tube (ETT) cuff pressure. The aim of the current study was to evaluate the effectiveness of automatic cuff pressure closed-loop control in patients under prolonged intubation, where presence of carbon dioxide (CO2) in the subglottic space is used as an indicator for leaks. The primary outcome of the study is leakage around the cuff quantified using the area under the curve (AUC) of CO2 leakage over time. ⋯ This study shows that the automatic cuff pressure group is not only noninferior but also superior compared to the manual cuff pressure group. Thus, the use of automatic cuff pressure control based on subglottic measurements of CO2 levels is an effective method for ETT cuff pressure optimization. The method is safe and can be easily utilized with any intubated patient.
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Anesthesia and analgesia · Aug 2017
Randomized Controlled Trial Multicenter StudyA Perioperative Smoking Cessation Intervention With Varenicline, Counseling, and Fax Referral to a Telephone Quitline Versus a Brief Intervention: A Randomized Controlled Trial.
The effectiveness of perioperative interventions to quit smoking with varenicline has not been compared with brief interventions. Our objective was to determine the efficacy of a comprehensive smoking cessation program versus a brief intervention for smoking cessation. ⋯ A perioperative smoking cessation program with counseling, pharmacotherapy with varenicline, an educational pamphlet, and a fax referral to a quitline increased abstinence from smoking 1, 3, 6, and 12 months after surgery versus a brief intervention.
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Anesthesia and analgesia · Aug 2017
Multicenter Study Observational StudySevere Intraoperative Hyperglycemia Is Independently Associated With Postoperative Composite Infection After Craniotomy: An Observational Study.
Postoperative infection after craniotomy carries an increased risk of morbidity and mortality. Identification and correction of the risk factors should be prioritized. The association of intraoperative hyperglycemia with postoperative infections in patients undergoing craniotomy is inadequately studied. ⋯ SIH is independently associated with postoperative new-onset composite infections in patients undergoing craniotomy. Whether prevention of SIH during craniotomy results in a reduced postoperative risk of infection is unknown and needs to be appraised by further study.
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Anesthesia and analgesia · Aug 2017
Multicenter StudyEnhancing Feedback on Professionalism and Communication Skills in Anesthesia Residency Programs.
Despite its importance, training faculty to provide feedback to residents remains challenging. We hypothesized that, overall, at 4 institutions, a faculty development program on providing feedback on professionalism and communication skills would lead to (1) an improvement in the quantity, quality, and utility of feedback and (2) an increase in feedback containing negative/constructive feedback and pertaining to professionalism/communication. As secondary analyses, we explored these outcomes at the individual institutions. ⋯ We detected no overall changes but did detect different changes at each institution despite the identical intervention. The intervention may be more effective with new faculty and/or smaller discussion sessions. Future steps include refining the rating system, exploring ways to sustain changes, and investigating other factors contributing to feedback quality and utility.