Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2019
Comparative StudyNational Trends and Factors Associated With Inpatient Mortality in Adult Patients With Opioid Overdose.
The prevalence of opioid misuse and opioid-related mortality has increased dramatically over the past decade. There is limited evidence on factors associated with mortality from opioid overdose in the inpatient setting. The primary objective was to report national trends in opioid overdose and mortality. The secondary objectives were to explore factors associated with inpatient mortality and report differences in prescription opioid overdose (POD) versus illicit opioid overdose (IOD) cohorts. ⋯ The increase in mortality provides a strong basis for further risk reduction strategies and intervention program implementation. Medical management of not only the opioid overdose but also the comorbidities calls for a multidisciplinary approach that involves policy makers and health care teams.
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Anesthesia and analgesia · Jan 2019
Intraoperative Hemodynamic and Echocardiographic Measurements Associated With Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation.
Severe right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation increases morbidity and mortality. We investigated the association between intraoperative right heart hemodynamic data, echocardiographic parameters, and severe versus nonsevere RVF. ⋯ Post-chest closure values of CVP and PAPi were significantly associated with severe RVF. Echocardiographic assessment of RV function post-CPB was weakly associated with severe RVF.
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Anesthesia and analgesia · Jan 2019
Comparative StudyTrainability of Cricoid Pressure Force Application: A Simulation-Based Study.
Aspiration of gastric contents is a leading cause of airway management-related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10-30 N during application of CP. ⋯ At baseline, performance was poor at achieving target forces specified by national guidelines. Simulation-based training improved the success rate, but no participant achieved the predefined threshold for proficiency.