Journal of clinical anesthesia
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Controlled Clinical Trial
The effects of maternal presence during anesthesia induction on salivary cortisol levels in children undergoing tonsillectomy and/or adenoidectomy.
Although parental presence during anesthesia induction is suggested to diminish operative stress level in children, there have been conflicting results about this strategy. The aim of this study was to evaluate the effects of maternal presence during induction on operative stress level in children who had tonsillectomy and/or adenoidectomy by determining the salivary cortisol levels. ⋯ We have determined decreased salivary cortisol levels during anesthesia induction and recovery in the maternal presence revealing diminished stress in these periods. Further studies are warranted to determine the effects of parental presence during anesthesia induction especially on surgical outcomes.
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To examine the risk of perioperative stroke on in-hospital morbidity and mortality in staged coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures. ⋯ Analysis of 2761 patients over a period of 12years (1999-2011) indicate perioperative stroke to be a strong post-operative predicator of in-hospital mortality and morbidity for staged procedures. Other significant factors such as advancing age, female gender and comorbidities like CHF, left ventricular dysfunction (LVD) and post-operative MI should also be considered when determining patient risk. Further investigative studies on staged CABG and CEA procedures are needed for better patient selection and for implementing preventative strategies such as neuroprotective medication and neuromonitoring to minimize the risk of ischemic strokes.
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Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to develop and examine the effectiveness of the Internet-delivered, preoperative program (I-PPP) in alleviating prepoperative anxiety in children undergoing outpatient surgery. In Study 1, the I-PPP was developed and then evaluated by parent/child dyads and health care professionals. In Study 2, the effectiveness of I-PPP was examined. ⋯ Our findings suggest that I-PPP represents a viable option for preoperative preparation for children and their parents.
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Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure. ⋯ This single center retrospective study quantified a high perioperative risk for critically ill patients with advanced airways: one in four did not survive to discharge. Preoperative ASA score, RCRI, and SOFA score only partially delineated survivors and non-survivors. Given the existing limitations, future research may identify assessment tools more relevant to discriminating survival outcomes for critically ill patients in the perioperative environment.
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Selecting candidates for residency positions is challenging and there is little research on the correlation between commonly used selection criteria and subsequent performance in anesthesiology. This study examined the association between the selection measures and post-recruitment performance in residency. ⋯ Comparative performance with classmates (i.e., class rank) in medical school appeared to be an effective predictor of overall performance in residency, which warrants more attention in future study. Although interview performance is subject to recruitment team members' interpretation, it is an important measure to include in recruitment decisions.