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    24204 results match your criteria Anesthesia and analgesia[Journal]

    1 OF 485

    In Response: Investigation of 2 Prototypes of Novel Noncontact Technologies for Automated Real-Time Capture of Incremental Drug Administration Data From Syringes.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    Morriston Hospital, ABM University Health Board, Swansea, United Kingdom Welsh Centre for Burns, ABM University Health Board, Swansea, United Kingdom, Swansea University College of Medicine, Swansea, United Kingdom ABM University Health Board, Swansea, United Kingdom, Swansea University College of Medicine, Swansea, United Kingdom,

    Perioperative Steroid Use for Tonsillectomy and Its Association With Reoperation for Posttonsillectomy Hemorrhage: A Retrospective Cohort Study.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    From the Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
    Background: Steroids reduce postoperative complications after tonsillectomy such as nausea and vomiting, pain, and delayed recovery. However, steroids may also increase the risk of severe posttonsillectomy bleeding requiring reoperation.

    Methods: To evaluate the risk of postoperative bleeding requiring reoperation related to perioperative steroid use, we conducted a retrospective cohort study of 6149 patients treated at 68 hospitals using a hospital-based claims database. Read More

    Total Intravenous Anesthesia and Target Controlled Infusions: A Comprehensive Global Anthology.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand, Department of Anaesthesia, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, Department of Anaesthesia, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

    Effect of Remote Ischemic Preconditioning on Outcomes in Adult Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    Background: Remote ischemic preconditioning (RIPC) has been demonstrated to prevent organ dysfunction in cardiac surgery patients. However, recent large, prospective, multicenter, randomized controlled trials (RCTs) had controversial results. Thus, a meta-analysis of RCTs was performed to investigate whether RIPC can reduce the incidence of acute myocardial infarction (AMI), acute kidney injury (AKI), and mortality in adult cardiac surgery patients. Read More

    Design and Evaluation of a Closed-Loop Anesthesia System With Robust Control and Safety System.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    Background: Closed-loop control of anesthesia involves continual adjustment of drug infusion rates according to measured clinical effect. The NeuroSENSE monitor provides an electroencephalographic measure of depth of hypnosis (wavelet-based anesthetic value for central nervous system monitoring [WAVCNS]). It has previously been used as feedback for closed-loop control of propofol, in a system designed using robust control engineering principles, which implements features specifically designed to ensure patient safety. Read More

    Management of 1-Lung Ventilation-Variation and Trends in Clinical Practice: A Report From the Multicenter Perioperative Outcomes Group.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    Background: Lung-protective ventilation (LPV) has been demonstrated to improve clinical outcomes in surgical patients. There are very limited data on the current use of LPV for patients undergoing 1-lung ventilation (1LV) despite evidence that 1LV may be a particularly important setting for its use. In this multicenter study, we report trends in ventilation practice for patients undergoing 1LV. Read More

    Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    From the Department of Anesthesiology, Division of Women's Anesthesia, Duke University School of Medicine, Durham, North Carolina.
    Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. Read More

    Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors Are Not Associated With Bleeding or Transfusion in Cardiac Surgical Patients.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    From the Department of Anesthesiology and Perioperative Medicine, Department of Biomedical Statistics and Informatics, Anesthesia Clinical Research Unit, and Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
    Background: Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) use is known to alter platelet activation and aggregation leading to impairment in hemostasis. Previous studies are ambiguous with regard to bleeding, transfusion, and perioperative complications in patients undergoing cardiac surgery. The purpose of this study was to evaluate the risk of perioperative bleeding, transfusion, morbidity, and mortality in cardiac surgical patients taking SSRI/SNRIs compared with propensity-matched controls. Read More

    Large Variability in the Diversity of Physiologically Complex Surgical Procedures Exists Nationwide Among All Hospitals Including Among Large Teaching Hospitals.
    Anesth Analg 2017 Nov 22. Epub 2017 Nov 22.
    Background: Multiple previous studies have shown that having a large diversity of procedures has a substantial impact on quality management of hospital surgical suites. At hospitals with substantial diversity, unless sophisticated statistical methods suitable for rare events are used, anesthesiologists working in surgical suites will have inaccurate predictions of surgical blood usage, case durations, cost accounting and price transparency, times remaining in late running cases, and use of intraoperative equipment. What is unknown is whether large diversity is a feature of only a few very unique set of hospitals nationwide (eg, the largest hospitals in each state or province). Read More

    Consensus Statement on Perioperative Use of Neuromuscular Monitoring.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management. The panel believes that whenever a neuromuscular blocker is administered, neuromuscular function must be monitored by observing the evoked muscular response to peripheral nerve stimulation. Read More

    A World of Need.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Department of Anaesthesia and Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.

    Survival of Staphylococcus epidermidis in Propofol and Intralipid in the Dead Space of Intravenous Injection Ports.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    From the Departments of Anesthesiology & Pain Medicine and Surgery, University of Alberta, Edmonton, Alberta, Canada.
    We tested whether propofol or Intralipid inoculated with Staphylococcus epidermidis would promote bacterial growth within an intravenous (IV) injection hub, a site prone to bacterial contamination. In tubes incubated under optimal conditions, S epidermidis exhibited growth in Intralipid, but not in propofol. In contrast, within the IV hub incubated with either propofol or intralipid at room temperature, S epidermidis bacterial numbers declined with time, and virtually no contamination remained after 12 hours. Read More

    Decreased Parasympathetic Activity of Heart Rate Variability During Anticipation of Night Duty in Anesthesiology Residents.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Background: In residency programs, it is well known that autonomic regulation is influenced by night duty due to workload stress and sleep deprivation. A less investigated question is the impact on the autonomic nervous system of residents before or when anticipating a night duty shift. In this study, heart rate variability (HRV) was evaluated as a measure of autonomic nervous system regulation. Read More

    Tailored Holder for Continuous Echocardiographic Monitoring.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Hemodynamic monitoring is essential for prompt and effective interventions in intensive care unit patients. We developed a custom-made transthoracic echocardiography transducer holder consisting of transducer holder and skin patch attachment. This holder allowed continuous transthoracic echocardiography monitoring in 5 adult patients with circulatory failure due to shock, and 6 pediatric patients after successful percutaneous closure of a ventricular septal defect. Read More

    Evidence Basis for Regional Anesthesia in Ambulatory Anterior Cruciate Ligament Reconstruction: Part III: Local Instillation Analgesia-A Systematic Review and Meta-Analysis.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Background: Local infiltration analgesia offers effective postoperative analgesia after knee arthroplasty, but the role of its counterpart, local instillation analgesia (LIA), in anterior cruciate ligament reconstruction (ACLR) is unclear. This systematic review and meta-analysis evaluates the analgesic benefits of LIA for outpatient ACLR.

    Methods: We sought randomized controlled trials investigating the analgesic effects of LIA versus control in adults having outpatient ACLR and receiving multimodal analgesia (excluding nerve blocks, which are examined in parts I and II of this project). Read More

    Perioperative Management of the Patient With a Left Ventricular Assist Device for Noncardiac Surgery.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
    The pandemic of heart failure and the limited options for treatment of end-stage disease have resulted in an increase in the utilization of left ventricular assist devices (LVADs). Improvements in device technology and patient survival have led to an expanding population of patients requiring noncardiac surgery while on LVAD therapy, thus leading to a growing need for familiarity with the physiology of these patients. This review describes the functional mechanics of the most prevalent continuous-flow LVAD, the HeartMate II, and focuses on perioperative anesthetic concerns. Read More

    Visualization Improves Supraclavicular Access to the Subclavian Vein in a Mixed Reality Simulator.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Background: We investigated whether visual augmentation (3D, real-time, color visualization) of a procedural simulator improved performance during training in the supraclavicular approach to the subclavian vein, not as widely known or used as its infraclavicular counterpart.

    Methods: To train anesthesiology residents to access a central vein, a mixed reality simulator with emulated ultrasound imaging was created using an anatomically authentic, 3D-printed, physical mannequin based on a computed tomographic scan of an actual human. The simulator has a corresponding 3D virtual model of the neck and upper chest anatomy. Read More

    Randomized Clinical Trial of Preoperative High-Dose Methylprednisolone on Postoperative Pain at Rest After Laparoscopic Appendectomy.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Background: Methylprednisolone administered intravenously preoperatively has been shown to reduce pain, nausea, and fatigue after elective surgery. We aimed to show that 125 mg of methylprednisolone given intravenously 30 minutes before laparoscopic surgery for suspected appendicitis would reduce pain at rest during the first 3 postoperative days.

    Methods: A multicenter, parallel-group, double-blind, placebo-controlled study was conducted including patients 18 years of age and older with an American Society of Anesthesiologist class of I-III undergoing laparoscopic surgery for suspected appendicitis. Read More

    Reduced Left Ventricular Global Longitudinal Strain Predicts Prolonged Hospitalization: A Cohort Analysis of Patients Having Aortic Valve Replacement Surgery.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    From the Departments of Cardiothoracic Anesthesia, Quantitative Health Sciences and Outcomes Research, Thoracic and Cardiovascular Surgery, Outcomes Research, and Cardiothoracic Anesthesia and Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
    Background: Left ventricular ejection fraction (LVEF) is often preserved in patients with aortic stenosis and thus cannot distinguish between normal myocardial contractile function and subclinical dysfunction. Global longitudinal strain and strain rate (SR), which measure myocardial deformation, are robust indicators of myocardial function and can detect subtle myocardial dysfunction that is not apparent with conventional echocardiographic measures. Strain and SR may better predict postoperative outcomes than LVEF. Read More

    Cardiac Arrest in the Operating Room: Part 2-Special Situations in the Perioperative Period.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    As noted in part 1 of this series, periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA. Read More

    Informed Consent and Cognitive Dysfunction After Noncardiac Surgery in the Elderly.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Cognitive dysfunction 3 months after noncardiac surgery in the elderly satisfies informed consent thresholds of foreseeability in 10%-15% of patients, and materiality with new deficits observed in memory and executive function in patients with normal test performance beforehand. At present, the only safety step to avoid cognitive dysfunction after surgery is to forego surgery, thereby precluding the benefits of surgery with removal of pain and inflammation, and resumption of normal nutrition, physical activity, and sleep. To assure that consent for surgery is properly informed, risks of both cognitive dysfunction and alternative management strategies must be discussed with patients by the surgery team before a procedure is scheduled. Read More

    In Response.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Christchurch Hospital and University of Otago, Christchurch, New Zealand World Federation of Societies of Anaesthesiologists, London, United Kingdom, Baerum Hospital, Sandvika, Norway World Federation of Societies of Anaesthesiologists, London, United Kingdom World Federation of Societies of Anaesthesiologists, London, United Kingdom Christchurch Hospital, Christchurch, New Zealand Workforce Working Group, World Federation of Societies of Anaesthesiologists, London, United Kingdom.

    Is Compliance With Surgical Care Improvement Project Cardiac (SCIP-Card-2) Measures for Perioperative β-Blockers Associated With Reduced Incidence of Mortality and Cardiovascular-Related Critical Quality Indicators After Noncardiac Surgery?
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Background: While continuation of β-blockers (BBs) perioperatively has become a national quality improvement measure, the relationship between BB withdrawal and mortality and cardiovascular-related critical quality indicators has not been studied in a contemporary cohort of patients undergoing noncardiac surgery.

    Methods: For this retrospective study, the quality assurance database of a large community-based anesthesiology group practice was used to identify 410,288 surgical cases, 18 years of age or older, who underwent elective or emergent noncardiac surgical procedures between January 1, 2009, and December 31, 2014. Each surgical case that was withdrawn from BBs perioperatively was propensity matched by clinical and surgical characteristics to 4 cases that continued BBs perioperatively. Read More

    Respiratory Gas Analysis-Technical Aspects.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    From Cardiorespiratory Consulting, LLC, Cheshire, Connecticut.
    A technology-focused review of respiratory gas analysis, with an emphasis on carbon dioxide analysis, is presented. The measurement technologies deployed commercially are highlighted, and the basic principles and technical concerns of infrared spectroscopy and mainstream versus sidestream gas sampling are discussed. The specifications of particular interest to the clinician, accuracy and response time, and the related standard, with typical values for a capnometer, are presented. Read More

    Changing Default Ventilator Settings on Anesthesia Machines Improves Adherence to Lung-Protective Ventilation Measures.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    Perioperative lung-protective ventilation (LPV) can reduce perioperative pulmonary morbidity. We hypothesized that modifying default anesthesia machine ventilator settings would increase the use of intraoperative LPV. Default tidal volume settings on our anesthesia machines were decreased from 600 to 400 mL, and default positive end-expiratory pressure was increased from 0 to 5 cm H2O. Read More

    A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science.
    Anesth Analg 2017 Nov 30. Epub 2017 Nov 30.
    From the Departments of Anesthesiology, Internal Medicine, Orthopaedic Surgery, and Surgery, Duke University School of Medicine, Durham, North Carolina.
    Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinary reputation, quality, and/or service, whereas its destruction can be a consequence of poor management, unfavorable policy, decreased demand, and/or increased competition. Going forward, payment for health care delivery will increasingly be based on services that contribute to improvements in individual and/or population health value, and funds to pay for health care delivery will become increasingly vulnerable to competitive market forces. Read More

    Validation of a Real-Time Minute-to-Minute Urine Output Monitor and the Feasibility of Its Clinical Use for Patients Undergoing Cardiac Surgery.
    Anesth Analg 2017 Dec;125(6):1883-1886
    From the *Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; †Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; ‡Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; and §Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
    Acute kidney injury after cardiac surgery is associated with increased morbidity and mortality. Methods for measuring urine output in real time may better ensure renal perfusion perioperatively in contrast to the current standard of care where urine output is visually estimated after empiric epochs of time. In this study, we describe an accurate method for monitoring urine output continuously during cardiopulmonary bypass. Read More

    Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge.
    Anesth Analg 2017 Dec;125(6):2113-2122
    Background: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy. Read More

    Oxycodone Ingestion Patterns in Acute Fracture Pain With Digital Pills.
    Anesth Analg 2017 Dec;125(6):2105-2112
    Background: Opioid analgesics are commonly prescribed on an as-needed (PRN) basis for acute painful conditions. Uncertainty of how patients actually take PRN opioids, coupled with a desire to completely cover pain, leads to variable and overly generous opioid prescribing practices, resulting in a surplus of opioids. This opioid surplus becomes a source for diversion and nonmedical opioid use. Read More

    Role of Urine Drug Testing in the Current Opioid Epidemic.
    Anesth Analg 2017 Dec;125(6):2094-2104
    From the Department of Anesthesiology & Pain Medicine, University of California, Davis, Sacramento, California.
    While the evidence for urine drug testing for patients on chronic opioid therapy is weak, the guidelines created by numerous medical societies and state and federal regulatory agencies recommend that it be included as one of the tools used to monitor patients for compliance with chronic opioid therapy. To get the most comprehensive results, clinicians should order both an immunoassay screen and confirmatory urine drug test. The immunoassay screen, which can be performed as an in-office point-of-care test or as a laboratory-based test, is a cheap and convenient study to order. Read More

    Using Integrative Medicine in Pain Management: An Evaluation of Current Evidence.
    Anesth Analg 2017 Dec;125(6):2081-2093
    Complementary medicine therapies are frequently used to treat pain conditions such as headaches and neck, back, and joint pain. Chronic pain, described as pain lasting longer than 3-6 months, can be a debilitating condition that has a significant socioeconomic impact. Pharmacologic approaches are often used for alleviating chronic pain, but recently there has been a reluctance to prescribe opioids for chronic noncancer pain because of concerns about tolerance, dependence, and addiction. Read More

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