Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
ReviewAnesthesia information-management systems: their role in risk-versus cost assessment and outcomes research.
Computerized clinical information systems clearly have a role in this era of managed care when outcomes research and cost/benefit analyses are becoming crucial. Despite anesthesiologists' leadership in developing physician-entry systems, automated recordkeeping systems have been underused. This report reviews the problems and possible solutions associated with establishing more effective and user-friendly systems in the anesthesia specialty. ⋯ To filter the vast amount of data collected by electronic medical-records systems in the ordinary course of care that are not applicable to a specific study, some form of filtering or data reduction on transfer to research or administrative databases will be needed. To allow careful analysis of possible correlations of outcome to care choices requires both the capture of the clinical context-a detailed description of all relevant conditions extending well beyond merely the objective vital signs-throughout a specific medical episode and the establishment of postoperative evaluation systems to allow outcomes capture. Connections to new as well as existing outcome data will provide vast new opportunities for outcomes research.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
ReviewCardiopulmonary bypass and the inflammatory response: a role for serine protease inhibitors?
Cardiopulmonary bypass has been shown to activate various inflammatory cascades in the body, resulting in pathophysiological changes that may affect patient outcome after cardiac surgery. Many of these inflammatory cascades are enzyme mediated, involving serine proteases. ⋯ Experimental data are reviewed on the action of aprotinin in inhibiting the intrinsic coagulation system and in limiting the contact activation of blood platelets and leukocytes. Also reviewed is the role of aprotinin in impacting the incidence of perioperative myocardial ischemia and the central nervous system dysfunction and stroke that are not infrequent complications of surgery with cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Somatosensory evoked potential monitoring during cardiac surgery: an examination of brachial plexus dysfunction.
To observe the effects of the Favoloro and sternal retractors on the ulnar and median nerve somatosensory evoked potentials (SSEPs) and to identify any relationship with postoperative brachial plexus injury. ⋯ SSEP changes correlate with the use of the sternal retractor but not the Favoloro retractor. It was not possible to replicate the results of previous investigators in predicting postoperative neurological deficits based on the SSEP changes, and therefore the routine application of SSEP as a monitor cannot be recommended on the basis on these data.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
A guide to preventing deep insertion of the cannulation needle during catheterization of the internal jugular vein.
Accidental puncture of the vertebral artery during the internal jugular vein cannulation produces lethal sequelae. To prevent this, the cannulation needle must not be inserted too deeply. However, there is no useful guide for the optimal length of insertion of the needle for accessing the internal jugular vein. The authors examined the length of the needle needed to reach the internal jugular vein with three different sizes of needle (16, 20, and 23 gauge). ⋯ The results may be a useful guide to prevent too deep insertion of the needle during internal jugular vein catheterization, especially when teaching residents who have limited experience with internal jugular vein catheterization.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Evaluation of an approach to choosing a left double-lumen tube size based on chest computed tomographic scan measurement of left mainstem bronchial diameter.
Evaluation of an approach to choosing left double-lumen tube size based on chest computed tomographic (CT) scan measurement of left bronchial diameter. ⋯ Chest CT scan measurement of left bronchial diameter can successfully guide the choice of left double-lumen tube size for an individual patient. In individuals with a small left bronchus measuring less than 10.0 mm in diameter, currently available adult double-lumen tube sizes will tightly wedge in their bronchus.