Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2020
Comparative StudyTiming and Risk Factors Associated With Postoperative Stroke in Vascular Surgery Patients Using Time-Varying Coefficients From a Cox Model.
Mechanisms of postoperative stroke are poorly understood, particularly for strokes occurring after uneventful emergence from anesthesia. We sought to create a model to study retrospectively the timing and associations for stroke in a high-risk surgery population. ⋯ After adjusting for confounding, stroke was more common and occurred earlier in the CV group. Factors associated with delayed postoperative stroke include acute renal failure, emergent procedures, female sex, preoperative mechanical ventilation, and perioperative transfusion.
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Anesthesia and analgesia · Mar 2020
Practical Training of Anesthesia Clinicians in Electroencephalogram-Based Determination of Hypnotic Depth of General Anesthesia.
Electroencephalographic (EEG) brain monitoring during general anesthesia provides information on hypnotic depth. We hypothesized that anesthesia clinicians could be trained rapidly to recognize typical EEG waveforms occurring with volatile-based general anesthesia. ⋯ A brief training session was associated with improvements in clinicians without prior EEG training in (1) identifying EEG waveforms corresponding to different hypnotic depths and (2) recognizing when the hypnotic depth suggested by the EEG was discordant with the pEEG index.
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Anesthesia and analgesia · Mar 2020
ReviewEducating Patients Regarding Pain Management and Safe Opioid Use After Surgery: A Narrative Review.
In recent years, there have been escalating concerns related to the opioid epidemic. With a steadily increasing opioid supply, it is critical to provide proper education to patients who are prescribed these medications. Education should be emphasized as a means of ensuring safe use and potentially as a strategy for curbing the opioid supply. ⋯ Patients who are prescribed opioids require education preoperatively to cover the topics of pain management, opioid-related side effects, and risks, storage, and disposal. Evidence from various studies demonstrates that educational interventions improve knowledge and potentially lead to safer behaviors and reduced opioid use. Education can be provided in various formats with each having unique advantages and limitations.
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Anesthesia and analgesia · Mar 2020
Randomized Controlled TrialPharmacokinetic and Pharmacodynamic Analysis of Alfaxalone Administered as a Bolus Intravenous Injection of Phaxan in a Phase 1 Randomized Trial.
Previous formulations of alfaxalone have shown it to be a fast-acting intravenous anesthetic with high therapeutic index. Alfaxalone has been reformulated for human use as Phaxan, an aqueous solution of 10 mg/mL of alfaxalone and 13% betadex. This study assessed the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of alfaxalone given as a bolus intravenous injection of this formulation to human male volunteers. ⋯ After a single bolus intravenous injection, alfaxalone has a high plasma CL equal to hepatic blood flow as reported for earlier studies of bolus injections of a previous formulation of alfaxalone. The plasma levels associated with BIS values of <60 are comparable to those previously reported in patients anesthetized with alfaxalone. The t1/2keo is relatively high, but the large Hill coefficient contributes to rapid onset and offset of action. This information can inform future studies of this formulation.