Journal of clinical anesthesia
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Randomized Controlled Trial
Combined femoral artery block and femoral nerve block reduces thigh tourniquet-induced hypertension.
Tourniquet hypertension (TH) is thought to be caused by sympathetically mediated C-fibers in the femoral epicardium following prolonged intraoperative inflation of the tourniquet, and we hypothesized that blocking the femoral artery at the same time as a conventional femoral nerve block would reduce the incidence of TH. ⋯ The present study demonstrated that modified femoral nerve block reduced intraoperative esmolol dosage and the incidence of TH.
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Randomized Controlled Trial
Lung-protective ventilation during Trendelenburg pneumoperitoneum surgery: A randomized clinical trial.
Study objective To assess the effects of a protective ventilation strategy during Trendelenburg pneumoperitoneum surgery on postoperative oxygenation. ⋯ In obese patients undergoing Trendelenburg pneumoperitoneum surgery, PV did not improve postoperative oxygenation nor day-2 respiratory function. PV was associated with intraoperative respiratory mechanics indicating less injurious ventilation. The high prevalence of complete airway closure may have affected study results.
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Observational Study
The efficacy of multifaceted versus single anesthesia work area infection control measures and the importance of surgical site infection follow-up duration.
Earlier a randomized trial showed efficacy of a multifaceted intervention approach for reducing surgical site infection: hand hygiene, vascular care, environmental cleaning, patient decolonization (nasal povidone iodine, chlorhexidine wipes), with feedback on pathogen transmission. The follow-up prospective observational study showed effectiveness when applied to all operating rooms of an inpatient surgical suite. In practice, many organizations will at baseline not be using conditions equivalent to the control groups but instead functionally have had ongoing a single intervention for infection control (e.g., encouraging better hand hygiene). Organizations also differ in how well and long they survey every surgical patient for postoperative surgical site infection. Thus, estimation of the expected net cost savings from implementing multifaceted intervention depends on the relative efficacy of multifaceted approach versus single intervention approaches and on the incidence of surgical site infection, the latter depending itself on the monitoring period for infection development. ⋯ An evidence-based, multifaceted approach to anesthesia work area infection control can generate substantial reductions in surgical site infections. A follow-up period of at least 60-days is indicated for infection detection.
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Immediate postoperative extubation (IPE) can reduce perioperative complications and length of stay (LOS), however it is performed variably after liver transplant across institutions and has historically excluded high-risk recipients from consideration. In late 2012, we planned and implemented a single academic institution structured quality improvement (QI) initiative to standardize perioperative care of liver transplant recipients without exceptions. We hypothesized that such an approach would lead to a sustained increase in IPE after primary (PAC) and delayed abdominal closure (DAC). ⋯ A structured QI initiative led to sustained high rates of IPE and reduced LOS in all liver transplant recipients, including those classified as high risk.
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Comment Letter Randomized Controlled Trial
Comment on: Sevoflurane requirements during electroencephalogram (EEG)-guided vs standard anesthesia Care in Children: A randomized controlled trial.