Journal of anesthesia
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Journal of anesthesia · Jun 2019
Case ReportsPerioperative point of care ultrasound in pediatric anesthesiology: a case series highlighting real-time intraoperative diagnosis and alteration of management augmenting physical examination.
Use of diagnostic point of care ultrasound, has come to the forefront of interest within anesthesiology. Much data on the use of point of care ultrasound in emergency medicine and critical care medicine for diagnosis and treatment in acute situations exists. While use of point of care ultrasound has become more prevalent in anesthesia practice, documentation of its use and especially alteration in management based on real-time ultrasound findings in the perioperative period remains scarce. This case series discusses six pediatric patients in which real-time intra-operative use of point of care ultrasound resulted in alteration of management.
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Journal of anesthesia · Jun 2019
Review Meta Analysis Comparative StudyComparison of invasive and noninvasive blood hemoglobin measurement in the operating room: a systematic review and meta-analysis.
Noninvasive hemoglobin (Hb)-monitoring devices are new inventions in pulse oximeter systems that show hemoglobin levels continuously. The aim of this systematic review and meta-analysis was to evaluate the accuracy and precision of noninvasive versus standard central laboratory Hb measurements in the operating room. We systematically searched multiple databases. ⋯ A total of 28 studies on 2000 participants were included in the meta-analysis. Meta-analysis results of mean differences between noninvasive and the central laboratory Hb measurements in overall pooled random effects were - 0.27 (95% LoA (0.44, - 0.10); P value < 0.05). According to this meta-analysis, noninvasive hemoglobin measurement has acceptable accuracy in comparison with the standard invasive method.
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Journal of anesthesia · Jun 2019
Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children.
While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs). ⋯ Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from "availability bias". Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.
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Journal of anesthesia · Jun 2019
ReviewInfraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system.
Over the last decade, considerable progress has been made regarding infraclavicular brachial plexus block (ICB) in adults, especially since the introduction of ultrasound guidance. The advancements in ICB have been attributed to the development of various approaches to improve the success rate and reduce complications. This has also necessitated a unified nomenclature system to facilitate comparison among different approaches. ⋯ For continuous ICB, the proximal approach is promising for reducing local anesthetic volume and increasing efficacy. Nevertheless, further studies are warranted in this direction. We provide practice advisories to maximize safety and minimize adverse events, and recommend designing future studies on ICB according to these findings based on the unified nomenclature system.