Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2018
Changing Default Ventilator Settings on Anesthesia Machines Improves Adherence to Lung-Protective Ventilation Measures.
Perioperative lung-protective ventilation (LPV) can reduce perioperative pulmonary morbidity. We hypothesized that modifying default anesthesia machine ventilator settings would increase the use of intraoperative LPV. ⋯ This modification increased mean positive end-expiratory pressure from 3.1 to 5.0 cm H2O and decreased mean tidal volume from 8.2 to 6.7 mL/kg predicted body weight. Notably, increased adherence to LPV from 1.6% to 23.0% occurred quickly with the rate of increase more than doubling from 1.8% to 3.9% per year.
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Anesthesia and analgesia · Apr 2018
Randomized Controlled TrialEfficacy of Ultrasound-Guided Serratus Plane Block on Postoperative Quality of Recovery and Analgesia After Video-Assisted Thoracic Surgery: A Randomized, Triple-Blind, Placebo-Controlled Study.
The optimal regional technique for analgesia and improved quality of recovery after video-assisted thoracic surgery (a procedure associated with considerable postoperative pain) has not been established. The main objective in this study was to compare quality of recovery in patients undergoing serratus plane block (SPB) with either ropivacaine or normal saline on the first postoperative day. Secondary outcomes were analgesic outcomes, including postoperative pain intensity and opioid consumption. ⋯ Single-injection SPB with ropivacaine enhanced the quality of recovery for 2 days postoperatively and improved postoperative analgesia during the early postoperative period in patients undergoing video-assisted thoracic surgery.
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Anesthesia and analgesia · Apr 2018
Implementation of a Standardized Transfusion Protocol for Cardiac Patients Treated With Venoarterial Extracorporeal Membrane Oxygenation Is Associated With Decreased Blood Component Utilization and May Improve Clinical Outcome.
Extracorporeal membrane oxygenation supplies oxygenated blood to the body supporting the heart and lungs. Survival rates of 20% to 50% are reported among patients receiving ECMO for cardiac arrest, severe cardiogenic shock, or failure to wean from cardiopulmonary bypass following cardiac surgery. Bleeding is one of the most common complications in ECMO patients due to coagulopathy, systemic anticoagulation, and the presence of large bore cannulas at systemic pressure. Absence of a standardized transfusion protocol in this population leads to inconsistent transfusion practices. Here, we assess a newly developed dedicated transfusion protocol in this clinical setting. ⋯ Our data indicate that implementation of a standardized transfusion protocol, using more restrictive transfusion indications in cardiac ECMO patients, was associated with reduced blood product utilization, decreased complications, and improved survival. This multidepartmental approach facilitates better communication and adherence to consensus clinical decision making between intensive care unit, surgery, and transfusion service and optimizes care of complicated and acutely ill patients.
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Anesthesia and analgesia · Apr 2018
Observational StudyAirway Management by Laryngeal Mask Airways for Cervical Tracheal Resection and Reconstruction: A Single-Center Retrospective Analysis.
Supraglottic airway devices (SADs) may have advantages over endotracheal intubation for tracheal resection and reconstruction in cases of severe and proximally located subglottic stenosis. This retrospective case series examines the feasibility of using SADs as a novel approach to airway management in tracheal resections. ⋯ This retrospective case series demonstrates the feasibility of using supraglottic airways alongside high-frequency jet ventilation for airway management in at least some cases of cervical tracheal resection and reconstruction. However, the small number of cases examined limits conclusions regarding indications, contraindications, and periprocedural safety.
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There is an urgent need to train more anesthesia providers in low- and middle-income countries (LMICs). There is also a need to provide more educational opportunities in subspecialty areas of anesthetic practice such as trauma management, pain management, obstetric anesthesia, and pediatric anesthesia. Together, these subspecialty areas make up a large proportion of the clinical workload in LMICs. ⋯ There is an emphasis on local ownership of the educational process that helps to promote sustainability. After an initial financial outlay to purchase equipment, the costs are relatively low. Short subspecialty courses appear to be part of the educational answer in LMICs, but there is a need for research to validate their role.