Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2020
ReviewPerioperative Management of Children on Ketogenic Dietary Therapies.
Ketogenic diet therapy (KDT) is an effective treatment modality for children with drug-resistant epilepsy and certain other metabolic and neurologic disorders. With a resurgence of interest in KDT, pediatric anesthesiologists are increasingly encountering children on KDT for a variety of surgical and medical procedures. ⋯ Recommendations for the perioperative anesthetic management of children on KDT are summarized. A comprehensive table listing the carbohydrate content of common anesthetic drugs is also included.
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Anesthesia and analgesia · Dec 2020
Multicenter StudyClinical Uses and Impacts of Emergency Manuals During Perioperative Crises.
Performing key actions efficiently during crises can determine clinical outcomes, yet even expert clinicians omit key actions. Simulation-based studies of crises show that correct performance of key actions dramatically increases when emergency manuals (EMs) are used. Despite widespread dissemination of EMs, there is a need to understand in clinical contexts, when, how, and how often EMs are used and not used, along with perceived impacts. ⋯ This study provides evidence that EMs in operating rooms are being used during many applicable crises and that clinicians perceive EM use to add value. The reported negative effects were minimal and potentially offset by positive effects.
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Anesthesia and analgesia · Dec 2020
Multicenter StudyAn Implementation-Effectiveness Study of a Perioperative Delirium Prevention Initiative for Older Adults.
Postoperative delirium is a common and serious problem for older adults. To better align local practices with delirium prevention consensus guidelines, we implemented a 5-component intervention followed by a quality improvement (QI) project at our institution. ⋯ A perioperative delirium prevention intervention was associated with reduced administration of Beers PIMs to older adults.
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Anesthesia and analgesia · Dec 2020
Trends and Outcomes in Pediatric Patients Undergoing Scoliosis Repair: A Population-Based Study.
Although surgery represents the only definitive treatment for congenital scoliosis, comprehensive information regarding trends in perioperative complications, particularly in the pediatric setting, is lacking. We sought to identify trends in and factors associated with perioperative complications following pediatric scoliosis surgery. ⋯ Although the incidence of the studied adverse outcomes in scoliosis surgery has decreased over time, this study shows it remains relatively high (17%). The associations demonstrated help clarify factors associated with complications and may be useful in guiding interventions to improve outcomes.