Journal of anesthesia
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Journal of anesthesia · Jun 2014
Evaluation of multiwave pulse total-hemoglobinometer during general anesthesia.
The purpose of this prospective study was to evaluate the accuracy and trending ability of a four-wavelength pulse-total hemoglobinometer that continuously and noninvasively measures hemoglobin in surgical patients. With IRB approval and informed consent, spectrophotometric hemoglobin (SpHb) was measured with a pulse-total hemoglobinometer manufactured by Nihon Kohden Corp (Tokyo, Japan) and compared to the CO-oximeter equipped with blood gas analyzer. Two hundred twenty-five samples from 56 subjects underwent analysis. ⋯ The percentages of samples with intermediate risk of therapeutic error in error grid analysis and the concordance rate of 4-quadrant trending assay was 17 % and 77 %, respectively. The Cohen kappa statistic for Hb < 10 g/dl was 0.38, suggesting that the agreement between SpHb and CO-oximeter-derived Hb was fair. Collectively, wide limits of agreement, especially at the critical level of hemoglobin, and less than moderate agreement against CO-oximeter-derived hemoglobin preclude the use of the pulse-total hemoglobinometer as a decision-making tool for transfusion.
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Journal of anesthesia · Jun 2014
Improvement of teamwork and safety climate following implementation of the WHO surgical safety checklist at a university hospital in Japan.
With the aim to optimize surgical safety, the World Health Organization (WHO) introduced the Surgical Safety Checklist (SSCL) in 2008. The SSCL has been piloted in many countries worldwide and shown to improve both safety attitudes within surgical teams and patient outcomes. In the study reported here we investigated whether implementation of the SSCL improved the teamwork and safety climate at a single university hospital in Japan. ⋯ A before and after design was used, with the questionnaire administered before and 3 months after SSCL implementation. Our analysis revealed that the mean scores on the SAQ had significantly improved 3 months after implementation of the SSCL compared to those before implementation. This finding implies that effective implementation of the SSCL could improve patient outcomes in Japan, similar to the findings of the WHO pilot study.
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Journal of anesthesia · Jun 2014
The impact of pretreatment with bolus dose of enteral glutamine on acute lung injury induced by oleic acid in rats.
Both parenteral and enteral glutamine have shown beneficial effects in sepsis and ischemia/reperfusion-induced acute lung injury (ALI). Oleic acid (OA) has been used to induce ALI in experimental studies. In this study, we investigated the effects of pretreatment of a bolus dose of enteral glutamine on ALI induced by OA in rats. ⋯ Pretreatment with a bolus dose of enteral glutamine minimized the extent of ALI induced by OA in rats.
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Journal of anesthesia · Jun 2014
Implications of dedicated tracheostomy care nurse program on outcomes.
Tracheostomy is a common occurrence in intensive care units (ICU), and a greater number of tracheostomized patients are shifted from ICU to non-critical areas. Tracheostomy care needs a multidisciplinary approach, particularly involving the nurses, and complications such as tube blockage, infection, and bleeding can be prevented by good bedside nursing. The aim was to study the impact of dedicated tracheostomy care nurse program on outcomes of tracheostomized patients. ⋯ The support of a specialist tracheostomy nurse can decrease complication rates and readmissions to the ICU and reduce ALOS.
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Journal of anesthesia · Jun 2014
Is preoperative period associated with severity and unexpected death of injured patients needing emergency trauma surgery?
Early operative control of hemorrhage is the key to saving the lives of severe trauma patients. We investigated whether emergency room (ER) stay time [time from the ER to the operating room (OR)] is associated with trauma severity and unexpected trauma death [Trauma and Injury Severity Score (TRISS) method-based probability of survival (Ps) ≥0.5 but died] of injured patients needing emergency trauma surgery. ⋯ Our results suggest that all medical staff should work together effectively on high-risk patients in the ER, bringing them immediately to the OR according to their level of risk. If injured patients need emergency trauma surgery, ER stay times should be kept as short as possible to reduce unexpected trauma death.