Anesthesiology research and practice
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Anesthesiol Res Pract · Jan 2015
Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children's Hospital.
This small (N=64) post-operative audit of children receiving muscle relaxants in an Australian tertiary paediatric hospital identified a 28% incidence of post-operative residual paralysis, measured immediately before extubation.
Worryingly, the incidence of residual paralysis was even higher in the subgroup reversed with neostigmine (38%), which the authors attribute to anaesthetists not waiting long enough after administration.
Severe residual paralysis (TOFR < 0.7) was observed in 7% of cases.
Only 23% of anaesthetists used intra-operative neuromuscular monitoring.
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Anesthesiol Res Pract · Jan 2015
ReviewPotential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review.
Anaesthetists in the acute and chronic pain teams are often involved in treating Complex Regional Pain Syndromes. Current literature about the risk factors for the onset of Complex Regional Pain Syndrome Type 1 (CRPS 1) remains sparse. This syndrome has a low prevalence, a highly variable presentation, and no gold standard for diagnosis. ⋯ Eligible articles were analysed, dated 1996 to April 2014, and potential risk factors for the onset of CRPS 1 were identified from 10 prospective and 6 retrospective studies. Potential risk factors for the onset of CRPS 1 were found to include being female, particularly postmenopausal female, ankle dislocation or intra-articular fracture, immobilisation, and a report of higher than usual levels of pain in the early phases of trauma. It is not possible to draw definite conclusions as this evidence is heterogeneous and of mixed quality, relevance, and weighting strength against bias and has not been confirmed across multiple trials or in homogenous studies.
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Anesthesiol Res Pract · Jan 2015
Effect of Ondansetron on the Occurrence of Hypotension and on Neonatal Parameters during Spinal Anesthesia for Elective Caesarean Section: A Prospective, Randomized, Controlled, Double-Blind Study.
To prevent hypotension during spinal anesthesia for caesarean section, we assessed IV ondansetron of invasive maternal hemodynamic and fetal gazometric parameters.
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Anesthesiol Res Pract · Jan 2015
Survey of Accepted Practice following Failed Intubation for Emergency Caesarean Delivery.
Background. There is no consensus on the optimum management of failed tracheal intubation in emergency cesarean delivery performed for fetal compromise. The decision making process on whether to wake the patient or continue anesthesia with a supraglottic airway device is an underexplored area. ⋯ Preoperative patient consent regarding the use of a supraglottic airway device for surgery in the event of failed intubation would affect the decision making of 40% of anaesthetists surveyed. Conclusion. These results demonstrate that a significant body of anesthetists with a subspecialty interest in obstetric anesthesia in the UK would not always wake up the patient and would continue with anesthesia and surgery with a supraglottic airway device in this setting.
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Anesthesiol Res Pract · Jan 2015
Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone.
Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. ⋯ Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure.