Articles: general-anesthesia.
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Journal of anesthesia · Jun 2022
Observational StudyCost-effectiveness analysis of sedation and general anesthesia regimens for children undergoing magnetic resonance imaging in Japan.
The anesthesiologist-directed sedation service has not been well established in Japan partly due to reimbursement issue. In this study, we compared the cost-effectiveness of sedation by non-anesthesiologists with that of sedation or general anesthesia by anesthesiologists under the Japanese medical fee schedule. ⋯ Anesthesia-directed sedation would be more cost-effective than oral or rectal sedation by non-anesthesiologists for children undergoing MRI in the Japanese medical fee schedule.
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A Hotline® fluid warmer is a device commonly used by anesthesia providers in the operating room to warm and infuse blood products and large fluid volumes. The purpose of the fluid warmer is to counter heat loss, which occurs under anesthesia. Despite normal checks performed prior to its use, we discovered a breach in the fluid warming set attached to the Hotline® fluid warmer during blood administration. ⋯ We describe the quality and safety processes we undertook in detail. We discuss the notion that monitoring alarms are an important safety feature of most modern devices utilized by anesthesia providers. We believe the Hotline® fluid warmer lacks a crucial monitor for detecting a breach within the fluid warming set, and therefore recommend the addition of an alarm to improve this device's safety.
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This study aims to compare the efficacy of ultrasound-guided interscalene block (US-ISB) with that of intravenous analgesia and sedation (IVAS) in reducing first shoulder dislocation. ⋯ Compared with IVAS group, US-ISB group reduces the time to discharge and achieves lesser complication. The pain score and reduction attempt are lower in the IVAS group than in the US-ISB group.
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Curr Opin Anaesthesiol · Jun 2022
ReviewMonitoring of analgesia level during general anesthesia in children.
Monitoring of intraoperative nociception has made substantial progress in adult anesthesia during the last 10 years. Several monitors have been validated and their use has been associated with intraoperative or postoperative benefits in the adult population. In pediatric anesthesia, less data are available. However, several recent publications have assessed the performance of nociception monitors in children, and investigated their potential benefits in this context. This review will describe the main validated intraoperative nociception monitors, summarize adult findings and describe the available pediatric data. ⋯ To date, four monitors may provide a relevant assessment of intraoperative nociception in children. However, the potential clinical benefits associated with their use to guide analgesia remain to be demonstrated.
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Anesthesia and analgesia · Jun 2022
ReviewApplication of Nonhuman Primate Models in the Studies of Pediatric Anesthesia Neurotoxicity.
Numerous animal models have been used to study developmental neurotoxicity associated with short-term or prolonged exposure of common general anesthetics at clinically relevant concentrations. Pediatric anesthesia models using the nonhuman primate (NHP) may more accurately reflect the human condition because of their phylogenetic similarity to humans with regard to reproduction, development, neuroanatomy, and cognition. ⋯ In this review, we discuss how neonatal NHP animals have been used for modeling pediatric anesthetic exposure; how NHPs have addressed key data gaps and application of the NHP model for the studies of general anesthetic-induced developmental neurotoxicity. The appropriate application and evaluation of the NHP model in the study of general anesthetic-induced developmental neurotoxicity have played a key role in enhancing the understanding and awareness of the potential neurotoxicity associated with pediatric general anesthetics.