Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study
LMA-ProSeal insertion by novice doctors as affected by a 90° bend created by an intubating stylet: a randomized clinical trial.
This study aimed to test the hypothesis that insertion of the supraglottic device LMA-ProSeal (ProSeal) by novice doctors in anesthetized patients can be improved by using an intubating stylet to create a 90° bend and that better sealing pressure is achieved. ⋯ Our results suggest that creating a 90° bend using an intubating stylet facilitates ProSeal insertion by novice doctors, as reflected by higher successful insertion rates, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.
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The objective was to analyze if an at-risk salary model for faculty anesthesiologists could improve on-time first case starts (FCSs) and case turnovers (TOs) in an academic hospital inpatient operating room (IOR) and ambulatory surgery center (ASC). Organizational goals were 65% and 70% on-time FCS and case TO times for IOR and ASC, respectively. ⋯ Anesthesiologists can drive efficiency in an operating room setting. By incentivizing on-time FCS and timely case TO with an at-risk salary model for faculty anesthesiologists, we were able to demonstrate a sustained significant improvement for these metrics. In both an inpatient and an ambulatory setting, operating room efficiency may be best served by aligning provider financial incentives with desired outcome metrics.
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Hypertrophic cardiomyopathy (HCM) presents a significant perioperative challenge. Anesthetic drugs, patient positioning, and surgical technique can provoke worsening left ventricular outflow tract obstruction and hemodynamic deterioration. In this case report, we present the perioperative management of a 70-year-old male with a history of HCM who underwent a robotic laparoscopic prostatectomy. Discussion focuses on the utilization of echocardiographic guidance in the care of patients with HCM undergoing noncardiac surgery, as well as the pathophysiology of laparoscopic insufflation and its effects on left ventricular outflow tract obstruction in HCM.
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Microbial contamination during preparation of the infusion drugs is an important issue in intensive care units. Objective of this study was to investigate in vitro antimicrobial properties of commonly used vasoactive drugs. ⋯ To limit microbial growth in case of contamination of the drug solution, it is advisable to use more concentrated dilutions of adrenaline, noradrenaline, and dopamine used in clinical practice.
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Neuraxial anesthesia has been widely used in China. Recently, Chinese anesthesiologists have applied nerve stimulator and ultrasound guidance for peripheral nerve blocks. Nationwide surveys about regional anesthesia practices in China are lacking. We surveyed Chinese anesthesiologists about regional anesthesia techniques, preference, drug selections, complications, and treatments. ⋯ The current survey can serve as a benchmark for future comparisons and evaluation of regional anesthesia practices in China. This survey revealed potential regional anesthesia safety issues in China.