Journal of clinical anesthesia
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Randomized Controlled Trial
The effect of driving pressure-guided versus conventional mechanical ventilation strategy on pulmonary complications following on-pump cardiac surgery: A randomized clinical trial.
Postoperative pulmonary complications occur frequently and are associated with worse postoperative outcomes in cardiac surgical patients. The advantage of driving pressure-guided ventilation strategy in decreasing pulmonary complications remains to be definitively established. We aimed to investigate the effect of intraoperative driving pressure-guided ventilation strategy compared with conventional lung-protective ventilation on pulmonary complications following on-pump cardiac surgery. ⋯ Among patients who underwent on-pump cardiac surgery, the use of driving pressure-guided ventilation strategy did not reduce the risk of postoperative pulmonary complications when compared with conventional lung-protective ventilation strategy.
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Observational Study
Association between maternal labour epidural analgesia and autistic traits in offspring.
Studies investigating associations between maternal epidural analgesia (MEA) and autism spectrum disorder (ASD) in the offspring are conflicting and lack prospective neurobehavioral follow-up assessments for autistic traits. We aim to prospectively investigate associations between MEA and autistic traits in the offspring. ⋯ MEA is not significantly associated with the development of ASD and autistic traits in offspring, assessed over 7 years. Results should be taken into perspective given our wide confidence intervals and small cohort size.
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Observational Study
Intraoperative hypotension in noncardiac surgery patients with chronic beta-blocker therapy: A matched cohort analysis.
To explore the incidence of intraoperative hypotension in patients with chronic beta-blocker therapy, expressed as time spent, area and time-weighted average under predefined mean arterial pressure thresholds. ⋯ In this matched cohort analysis, chronic beta-blocker therapy was not associated with increased exposure to intraoperative hypotension in patients undergoing intermediate- to high-risk noncardiac surgery. Furthermore, differences in patient subgroups and postoperative adverse cardiovascular events as a function of treatment regimen could not be demonstrated.
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Wiretapping laws generally govern the legality of surreptitious or unconsented audio recording or other interception of face-to-face conversations, telephone calls, and other oral or wire communications. Many of these laws were originally passed in the late 1960s or 70s, and many have since been modified or amended. Wiretap laws vary from state to state within the United States, and many clinicians as well as patients are often unaware of the scope and implications of these laws. ⋯ Our findings demonstrate heterogeneity with regard to the wiretapping laws state-to-state. The majority of punishments for violations involve fines and/or potential incarceration. Given the wide variability in state legislature, we suggest that anesthesiologists know their state's wiretapping law.
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We tested the hypothesis that pre-existing chronic pain is associated with prolonged time to reach sustained acceptable pain scores after major surgery. ⋯ Patients with chronic pain sustain more surgical pain than those without, and the pain takes longer to resolve. Clinicians providing postoperative pain management should consider the special needs of chronic pain patients.