Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2019
Comparative StudyPredosing Chemical Stability of Admixtures of Propofol, Ketamine, Fentanyl, and Remifentanil.
Admixtures of propofol-ketamine, propofol-ketamine-fentanyl, and propofol-ketamine-remifentanil were subjected to various clinically relevant conditions to study their chemical stability. A novel high-performance liquid chromatography-mass spectrometry method revealed no degradation of any compound by incubation at 37°C, constant mixing, or table-top storage for 6- and 24-hour time periods, except variable recovery of both propofol and fentanyl in the admixtures of propofol-ketamine-fentanyl suggesting possible degradation.
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Anesthesia and analgesia · Jul 2019
ReviewPoint-of-Care Blood Testing: The Technology Behind the Numbers.
Minutes count in the operating room when it comes to treatment guidance and therapies. On a daily basis, anesthesiologists make hundreds of decisions, some based on laboratory results, when guiding patient therapies. ⋯ Providers should be aware of the limitations, including the potential for error in results-errors that could lead to improper treatment and possible patient harm. This article outlines the technical aspects and summarizes pitfalls in accuracy for 2 of the most commonly utilized point-of-care testing devices: glucose meters and hemoglobin meters.
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Anesthesia and analgesia · Jul 2019
Comparative Study Observational StudyTrends in Authorship in Anesthesiology Journals.
Despite increasing representation in medicine, women continue to be a minority in academic practice and leadership, especially in male-dominated fields like anesthesiology. Differences in compensation and participation in leadership may represent barriers to career advancement for women in anesthesiology. Key factors for promotion in academic anesthesiology are research, funding, and publication. ⋯ Median number of authors was unrelated to senior author gender. This study shows increasing female first and senior authorship, as well as editorial board composition in 2 popular, high-impact anesthesiology journals. Recognizing gender-based trends in publications is important to develop strategies for the recruitment, retention, and advancement of women in anesthesiology.
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Anesthesia and analgesia · Jul 2019
Observational StudyClock Drawing Performance Slows for Older Adults After Total Knee Replacement Surgery.
Clock drawing is a neurocognitive screening tool used in preoperative settings. This study examined hypothesized changes in clock drawing to command and copy test conditions 3 weeks and 3 months after total knee arthroplasty (TKA) with general anesthesia. ⋯ Clock drawing construction slowed for nearly one-quarter of patients after TKA surgery, whereas nonsurgery peers showed the expected practice effect, ie, speed increased from baseline to follow-up time points. Future research should investigate the neurobiological basis for these changes after TKA.
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Anesthesia and analgesia · Jul 2019
Randomized Controlled Trial Comparative StudyPersonalized Versus Protocolized Fluid Management Using Noninvasive Hemodynamic Monitoring (Clearsight System) in Patients Undergoing Moderate-Risk Abdominal Surgery.
Advances in noninvasive hemodynamic monitoring systems allow delivery of goal-directed fluid therapy and could therefore be used in less-invasive surgical procedures. In this randomized controlled trial, we compared closed-loop-assisted goal-directed fluid therapy using a noninvasive cardiac output (Clearsight system) monitor (personalized approach) to a protocolized fluid therapy approach in 40 patients undergoing moderate-risk laparoscopic abdominal surgery. Cardiac output and stroke volume variations were not significantly different in both groups and remained within predefined target values >90% of the study time. Personalized fluid therapy does not seem to offer any hemodynamic advantage over a protocolized approach in this population.