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    24555 results match your criteria Anesthesia and analgesia[Journal]

    1 OF 492

    Development of a Rescue Echocardiography Protocol for Noncardiac Surgery Patients.
    Anesth Analg 2018 Jun 14. Epub 2018 Jun 14.
    Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
    Intraoperative transesophageal echocardiography (TEE) is a helpful diagnostic tool when hemodynamic compromise is encountered during noncardiac surgery. At our institution, a Rescue Echo Protocol was created to provide a structured means for requesting and performing a rescue TEE. We analyzed our institutional utilization of this service and found that it was used throughout the spectrum of patients' American Society of Anesthesiologists classifications and surgical services. Read More

    Comparison of Broadband and Discrete Wavelength Near-Infrared Spectroscopy Algorithms for the Detection of Cytochrome aa3 Reduction.
    Anesth Analg 2018 Jun 14. Epub 2018 Jun 14.
    From the Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia.
    Background: Cytochrome aa3, the terminal component of the electron transport chain, absorbs near-infrared radiation (NIR) differentially depending on its oxidation state (Cytox), which can in theory be measured using near-infrared spectroscopy (NIRS) by relating light absorption at specific wavelengths to chromophore concentrations. Some NIRS algorithms use discrete wavelengths, while others analyze a band of NIR (broadband NIRS). The purpose of this study was to test the ability of discrete wavelength and broadband algorithms to measure changes in Cytox (primary outcome), and to determine whether or not a discreet wavelength NIRS algorithm could perform similarly to a broadband NIRS algorithm for the measurement of Cytox in a staged hypoxia-cyanide model (hypoxia and cyanide have oppositional effects on tissue saturation, but both cause cytochrome reduction). Read More

    Parasympathetic Tone Activity Evaluation to Discriminate Ketorolac and Ketorolac/Tramadol Analgesia Level in Swine.
    Anesth Analg 2018 Jun 14. Epub 2018 Jun 14.
    From the Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB).
    Background: Evaluation of nociceptive-antinociceptive balance during general anesthesia is still challenging and routinely based on clinical criteria. Analgesic drug delivered may be optimized with parasympathetic tone activity (PTA) monitor. This study compares ketorolac and ketorolac/tramadol balance analgesia using a PTA monitor. Read More

    Association of Interindividual Variation in Plasma Oxytocin With Postcesarean Incisional Pain.
    Anesth Analg 2018 Jun 14. Epub 2018 Jun 14.
    From the Department of Anesthesiology, Perioperative and Pain Medicine.
    Oxytocin has known antinociceptive effects and is upregulated perinatally. This pilot study investigated the association of plasma oxytocin and postcesarean incisional pain. Plasma samples from 18 patients undergoing elective cesarean delivery were drawn at 1 hour preoperatively and 1 and 24 hours postoperatively and analyzed by using enzyme-linked immunosorbent assay. Read More

    A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring During Noncardiac Surgery.
    Anesth Analg 2018 Jun 14. Epub 2018 Jun 14.
    From the Departments of Outcomes Research.
    Background: Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy, thereby reducing intraoperative hypotension. We tested the hypothesis that continuous noninvasive blood pressure monitoring reduces intraoperative hypotension. Read More

    Repeated Measures Designs and Analysis of Longitudinal Data: If at First You Do Not Succeed-Try, Try Again.
    Anesth Analg 2018 Jun 12. Epub 2018 Jun 12.
    Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas.
    Anesthesia, critical care, perioperative, and pain research often involves study designs in which the same outcome variable is repeatedly measured or observed over time on the same patients. Such repeatedly measured data are referred to as longitudinal data, and longitudinal study designs are commonly used to investigate changes in an outcome over time and to compare these changes among treatment groups. From a statistical perspective, longitudinal studies usually increase the precision of estimated treatment effects, thus increasing the power to detect such effects. Read More

    Impact of Clinical Guidelines on Revisits After Ambulatory Pediatric Adenotonsillectomy.
    Anesth Analg 2018 Jun 12. Epub 2018 Jun 12.
    Department of Anesthesiology and Pain Medicine and the Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
    Background: Pediatric adenotonsillectomies are common and carry known risks of potentially severe complications. Complications that require a revisit, to either the emergency department or hospital readmission, increase costs and may be tied to lower reimbursements by federal programs. In 2011 and 2012, recommendations by pediatric and surgical organizations regarding selection of candidates for ambulatory procedures were issued. Read More

    Implementation of Perioperative Music Using the Consolidated Framework for Implementation Research.
    Anesth Analg 2018 Jun 12. Epub 2018 Jun 12.
    Anesthesiology Service, Durham Veterans Affairs (VA) Healthcare System, Durham, North Carolina.
    Background: Complementary integrative health therapies have a perioperative role in the reduction of pain, analgesic use, and anxiety, and increasing patient satisfaction. However, long implementation lags have been quantified. The Consolidated Framework for Implementation Research (CFIR) can help mitigate this translational problem. Read More

    Comparing Anesthesia Durations Among Hospitals Based on Statistical Methods Described in Previous Publications in Anesthesia & Analgesia.
    Anesth Analg 2018 Jun 12. Epub 2018 Jun 12.
    Department of Anesthesia, University of Iowa, Iowa City, Iowa, Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, Florida Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.

    In Response.
    Anesth Analg 2018 Jun 12. Epub 2018 Jun 12.
    Departments of Anesthesiology and Public Health Sciences, University of Rochester School of Medicine, Rochester, New York, RAND Health, RAND, Boston, Massachusetts, US Anesthesia Partners, Dallas, Texas Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, New York Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York RAND Health, RAND, Boston, Massachusetts.

    In Response.
    Anesth Analg 2018 Jun 8. Epub 2018 Jun 8.
    Department of Anesthesiology, Northshore University Hospital, Manhasset, New York, Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky Division of Cardiovascular Perfusion, Medical University of South Carolina, Charleston, South Carolina Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia.

    Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Total Knee Arthroplasty.
    Anesth Analg 2018 Jun 8. Epub 2018 Jun 8.
    From the Department of Anesthesiology, Hospital for Special Surgery/Weill Cornell Medical College, New York, New York.
    Enhanced recovery after surgery (ERAS) has rapidly gained popularity in a variety of surgical subspecialities. A large body of literature suggests that ERAS leads to superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost benefits, without affecting rates of readmission after surgery. These patterns have been described for patients undergoing elective total knee arthroplasty (TKA); however, adoption of ERAS to orthopedic surgery has lagged behind other surgical disciplines. Read More

    A Prospective Observational Study of Anesthesia-Related Adverse Events and Postoperative Complications Occurring During a Surgical Mission in Madagascar.
    Anesth Analg 2018 Jun 8. Epub 2018 Jun 8.
    Warren Alpert School of Medicine, Brown University, Providence, Rhode Island.
    Background: Two-thirds of the world's population lack access to safe anesthesia and surgical care. Nongovernmental organizations (NGOs) play an important role in bridging the gap, but surgical outcomes vary. After complex surgeries, up to 20-fold higher postoperative complication rates are reported and the reasons for poor outcomes are undefined. Read More

    Postoperative Cognitive Dysfunction and Noncardiac Surgery.
    Anesth Analg 2018 Jun 8. Epub 2018 Jun 8.
    From the Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia.
    Postoperative cognitive dysfunction (POCD) is an objectively measured decline in cognition postoperatively compared with preoperative function. POCD has been considered in the anesthetic and surgical literature in isolation of cognitive decline which is common in the elderly within the community and where it is labeled as mild cognitive impairment, neurocognitive disorder, or dementia. This narrative review seeks to place POCD in the broad context of cognitive decline in the general population. Read More

    The Future of Activated Clotting Time?
    Anesth Analg 2018 Jun 8. Epub 2018 Jun 8.
    Department of Anaesthesia, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom, Haemophilia Centre, Barts Health NHS Trust, London, United Kingdom Department of Haematology, Barts Health NHS Trust, London, United Kingdom, Queen Mary University of London, London, United Kingdom, NHS Blood and Transplant, London, United Kingdom Department of Haematology, Barts and The London School of Medicine and Dentistry, London, United Kingdom, Queen Mary University of London, London, United Kingdom, Barts Health NHS Trust, London, United Kingdom.

    Decision Support Tool Improves Real and Perceived Anesthesiology Resident Relief Equity.
    Anesth Analg 2018 Jun 5. Epub 2018 Jun 5.
    From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
    Background: The Accreditation Council of Graduate Medical Education requires monitoring of resident clinical and educational hours but does not require tracking daily work patterns or duty hour equity. Lack of such monitoring may allow for inequity that affects resident morale. No defined system for resident relief of weekday operating room (OR) clinical duties existed at our institution, leaving on-call residents to independently decide daily relief order. Read More

    Intraoperative Hemodynamic and Echocardiographic Measurements Associated With Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation.
    Anesth Analg 2018 Jun 5. Epub 2018 Jun 5.
    From the Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts.
    Background: Severe right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation increases morbidity and mortality. We investigated the association between intraoperative right heart hemodynamic data, echocardiographic parameters, and severe versus nonsevere RVF.

    Methods: A review of LVAD patients between March 2013 and March 2016 was performed. Read More

    Personalized Versus Protocolized Fluid Management Using Noninvasive Hemodynamic Monitoring (Clearsight System) in Patients Undergoing Moderate-Risk Abdominal Surgery.
    Anesth Analg 2018 Jun 5. Epub 2018 Jun 5.
    Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California.
    Advances in noninvasive hemodynamic monitoring systems allow delivery of goal-directed fluid therapy and could therefore be used in less-invasive surgical procedures. In this randomized controlled trial, we compared closed-loop-assisted goal-directed fluid therapy using a noninvasive cardiac output (Clearsight system) monitor (personalized approach) to a protocolized fluid therapy approach in 40 patients undergoing moderate-risk laparoscopic abdominal surgery. Cardiac output and stroke volume variations were not significantly different in both groups and remained within predefined target values >90% of the study time. Read More

    Cardiac Structure and Function in Morbidly Obese Parturients: An Echocardiographic Study.
    Anesth Analg 2018 Jun 5. Epub 2018 Jun 5.
    From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
    Background: The increasing prevalence of obesity worldwide is a major threat to global health. Cardiac structural and functional changes are well documented for obesity as well as for pregnancy, but there is limited literature on morbidly obese parturients. We hypothesized that there are both cardiac structural and functional differences between morbidly obese pregnant women and pregnant women of normal body mass index (BMI). Read More

    Resuscitation of Endotheliopathy and Bleeding in Thoracic Aortic Dissections: The VIPER-OCTA Randomized Clinical Pilot Trial.
    Anesth Analg 2018 May 31. Epub 2018 May 31.
    From the Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Denmark.
    Background: Thoracic aorta dissection is an acute critical condition associated with shock-induced endotheliopathy, coagulopathy, massive bleeding, and significant morbidity and mortality. Our aim was to compare the effect of coagulation support with solvent/detergent-treated pooled plasma (OctaplasLG) versus standard fresh frozen plasma (FFP) on glycocalyx and endothelial injury, bleeding, and transfusion requirements.

    Methods: Investigator-initiated, single-center, blinded, randomized clinical pilot trial of adult patients undergoing emergency surgery for thoracic aorta dissection. Read More

    Inhibition of Fatty Acid Amide Hydrolase Improves Depressive-Like Behaviors Independent of Its Peripheral Antinociceptive Effects in a Rat Model of Neuropathic Pain.
    Anesth Analg 2018 May 31. Epub 2018 May 31.
    From the Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
    Background: Neuropathic pain is often associated with depression. Enhancing endocannabinoids by fatty acid amide hydrolase (FAAH) inhibitors relieves neuropathic pain and stress-induced depressive-like behaviors in animal models. However, it is unclear whether FAAH inhibitor can relieve neuropathic pain-induced depression by or not by its antinociceptive effects. Read More

    Fibrinogen Concentrate in Cardiovascular Surgery: A Meta-analysis of Randomized Controlled Trials.
    Anesth Analg 2018 May 31. Epub 2018 May 31.
    Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, Ontario, Canada.
    Background: Postoperative bleeding remains a frequent complication after cardiovascular surgery and may contribute to serious morbidity and mortality. Observational studies have suggested a relationship between low endogenous plasma fibrinogen concentration and increased risk of postoperative blood loss in cardiac surgery. Although the transfusion of fibrinogen concentrate has been increasing, potential benefits and risks associated with perioperative fibrinogen supplementation in cardiovascular surgery are not fully understood. Read More

    Race/Ethnicity and Sex Both Affect Opioid Administration in the Emergency Room.
    Anesth Analg 2018 May 31. Epub 2018 May 31.
    From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
    Background: Although racial/ethnic and sex disparities have been examined in health care generally and pain management more specifically, the combined influence of these sociodemographic factors together has not been well documented. The aim of this study was to examine the association between administration of opioid analgesics in the emergency department (ED) and interaction of race/ethnicity and sex.

    Methods: We conducted a retrospective cohort study using 2010-2014 Center for Disease Control-National Hospital Ambulatory Medical Care Survey data for patients 12-55 years of age presenting to EDs with a primary diagnosis of appendicitis or gallbladder disease as defined by International Classification of Diseases, Ninth Revision codes. Read More

    Risks and Benefits of Ultrasound, Nerve Stimulation, and Their Combination for Guiding Peripheral Nerve Blocks: A Retrospective Registry Analysis.
    Anesth Analg 2018 May 31. Epub 2018 May 31.
    From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine.
    Background: Ultrasound, nerve stimulation, and their combination are all considered acceptable ways to guide peripheral nerve blocks. Which approach is most effective and associated with the fewest complications is unknown. We therefore used a large registry to analyze whether there are differences in vascular punctures, multiple skin punctures, and unintended paresthesia. Read More

    Opioid Use Disorders: Perioperative Management of a Special Population.
    Anesth Analg 2018 May 25. Epub 2018 May 25.
    From the Departments o Psychiatry and.
    Opioid-related overdose deaths have reached epidemic levels within the last decade. The efforts to prevent, identify, and treat opioid use disorders (OUDs) mostly focus on the outpatient setting. Despite their frequent overrepresentation, less is known about the inpatient management of patients with OUDs. Read More

    Readiness for Discharge After Foot and Ankle Surgery Using Peripheral Nerve Blocks: A Randomized Controlled Trial Comparing Spinal and General Anesthesia as Supplements to Nerve Blocks.
    Anesth Analg 2018 May 25. Epub 2018 May 25.
    Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York.
    Background: Neuraxial anesthesia is often viewed as superior to general anesthesia but may delay discharge. Comparisons do not typically use multimodal analgesics and nerve blockade. Combining nerve blockade with general anesthesia may reduce pain, opioid consumption, and nausea. Read More

    The Effect of Labor Epidural Analgesia on Breastfeeding Outcomes: A Prospective Observational Cohort Study in a Mixed-Parity Cohort.
    Anesth Analg 2018 May 25. Epub 2018 May 25.
    From the Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
    Background: The effect of labor epidural analgesia (LEA) on successful breastfeeding has been evaluated in several studies with divergent results. We hypothesized that LEA would not influence breastfeeding status 6 weeks postpartum in women who intended to breastfeed in an environment that encourages breastfeeding.

    Methods: In this prospective observational cohort study, a total of 1204 women intending to breastfeed, delivering vaginally with or without LEA, were included; breastfeeding was recorded at 3 days and 6 weeks postpartum. Read More

    Reversing Cholinergic Bronchoconstriction by Common Inotropic Agents: A Randomized Experimental Trial on Isolated Perfused Rat Lungs.
    Anesth Analg 2018 May 25. Epub 2018 May 25.
    Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
    Background: The ability of inotropic agents to alter airway reactivity and lung tissue mechanics has not been compared in a well-controlled experimental model. Therefore, we compared the potential to alter lung tissue viscoelasticity and bronchodilator effects of commonly used inotropic agents in an isolated perfused rat lung model.

    Methods: After achieving steady state lung perfusion, sustained bronchoconstriction was induced by acetylcholine (ACh). Read More

    Opening the Black Box: Understanding the Science Behind Big Data and Predictive Analytics.
    Anesth Analg 2018 May 25. Epub 2018 May 25.
    From the Department of Anesthesiology and Perioperative Medicine.
    Big data, smart data, predictive analytics, and other similar terms are ubiquitous in the lay and scientific literature. However, despite the frequency of usage, these terms are often poorly understood, and evidence of their disruption to clinical care is hard to find. This article aims to address these issues by first defining and elucidating the term big data, exploring the ways in which modern medical data, both inside and outside the electronic medical record, meet the established definitions of big data. Read More

    Mixing Studies in Patients With Prolonged Activated Partial Thromboplastin Time or Prothrombin Time.
    Anesth Analg 2018 May 25. Epub 2018 May 25.
    Department of Pathology (Coagulation Laboratory), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
    Background: Patients presenting for surgery may have isolated or combined prolonged activated partial thromboplastin time (aPTT) and/or prothrombin time (PT). In patients not receiving anticoagulants or with no identifiable cause for abnormal clot formation, a mixing study is performed. The index of circulating anticoagulant (ICA) has been used to predict the presence of an inhibitor, usually a lupus anticoagulant. Read More

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