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Anesthesiology

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https://www.readbyqxmd.com/read/28106610/-opt-out-and-access-to-anesthesia-care-for-elective-and-urgent-surgeries-among-u-s-medicare-beneficiaries
#1
Eric C Sun, Franklin Dexter, Thomas R Miller, Laurence C Baker
BACKGROUND: In 2001, the Centers for Medicare and Medicaid Services issued a rule allowing U.S. states to "opt out" of the regulations requiring physician supervision of nurse anesthetists in an effort to increase access to anesthesia care. Whether "opt out" has successfully achieved this goal remains unknown. METHODS: Using Medicare administrative claims data, we examined whether "opt out" reduced the distance traveled by patients, a common measure of access, for patients undergoing total knee arthroplasty, total hip arthroplasty, cataract surgery, colonoscopy/sigmoidoscopy, esophagogastroduodenoscopy, appendectomy, or hip fracture repair...
January 19, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28106609/should-we-fear-computers-or-the-lack-of-them-technology-digital-quality-improvement-and-the-care-redesign-process
#2
Allan F Simpao, Jorge A Gálvez, Maxime Cannesson
No abstract text is available yet for this article.
January 19, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28106608/a-perioperative-systems-design-to-improve-intraoperative-glucose-monitoring-is-associated-with-a-reduction-in-surgical-site-infections-in-a-diabetic-patient-population
#3
Jesse M Ehrenfeld, Jonathan P Wanderer, Maxim Terekhov, Brian S Rothman, Warren S Sandberg
BACKGROUND: Diabetic patients receiving insulin should have periodic intraoperative glucose measurement. The authors conducted a care redesign effort to improve intraoperative glucose monitoring. METHODS: With approval from Vanderbilt University Human Research Protection Program (Nashville, Tennessee), the authors created an automatic system to identify diabetic patients, detect insulin administration, check for recent glucose measurement, and remind clinicians to check intraoperative glucose...
January 19, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28099247/hypercoagulability-during-resternotomy-for-prosthetic-valve-endocarditis
#4
Andrew L Wilkey, Judah A Askew, Robert S Farivar, Tjorvi E Perry
No abstract text is available yet for this article.
January 18, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28099246/paradoxical-emergence-administration-of-subanesthetic-ketamine-during-isoflurane-anesthesia-induces-burst-suppression-but-accelerates-recovery
#5
Viviane S Hambrecht-Wiedbusch, Duan Li, George A Mashour
BACKGROUND: Promoting arousal by manipulating certain brain regions and/or neurotransmitters has been a recent research focus, with the goal of trying to improve recovery from general anesthesia. The current study tested the hypothesis that a single subanesthetic dose of ketamine during isoflurane anesthesia would increase cholinergic tone in the prefrontal cortex and accelerate recovery. METHODS: Adult male rats were implanted with electroencephalography electrodes (frontal, parietal, and occipital cortex) and a microdialysis guide cannula targeted for the prefrontal cortex...
January 18, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28099245/ketamine-a-drug-at-war-with-itself
#6
Paul Garcia, Jamie Sleigh
No abstract text is available yet for this article.
January 18, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28099244/presepsin-scd14-st-is-a-novel-marker-for-risk-stratification-in-cardiac-surgery-patients
#7
Hagen Bomberg, Matthias Klingele, Stefan Wagenpfeil, Eberhard Spanuth, Thomas Volk, Daniel I Sessler, Hans-Joachim Schäfers, Heinrich Volker Groesdonk
BACKGROUND: Presepsin (soluble cluster-of-differentiation 14 subtype [sCD14-ST]) is a humoral risk stratification marker for systemic inflammatory response syndrome and sepsis. It remains unknown whether presepsin can be used to stratify risk in elective cardiac surgery. The authors therefore determined the usefulness of presepsin for risk stratification in patients having elective cardiac surgery. METHODS: Eight hundred fifty-six cardiac surgical patients were prospectively studied...
January 18, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28099243/supraclavicular-brachial-plexus-block-in-the-presence-of-a-cervical-rib
#8
Monica Liu, Philip Peng
No abstract text is available yet for this article.
January 18, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28099242/acquired-bronchoesophageal-fistula-and-gastroesophageal-junction-mass
#9
Kenneth N Hiller, Paul G Loubser, Harold S Minkowitz, Mark T Goldstein
No abstract text is available yet for this article.
January 18, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28092321/dexmedetomidine-disrupts-the-local-and-global-efficiencies-of-large-scale-brain-networks
#10
Javeria A Hashmi, Marco L Loggia, Sheraz Khan, Lei Gao, Jieun Kim, Vitaly Napadow, Emery N Brown, Oluwaseun Akeju
BACKGROUND: A clear understanding of the neural basis of consciousness is fundamental to research in clinical and basic neuroscience disciplines and anesthesia. Recently, decreased efficiency of information integration was suggested as a core network feature of propofol-induced unconsciousness. However, it is unclear whether this finding can be generalized to dexmedetomidine, which has a different molecular target. METHODS: Dexmedetomidine was administered as a 1-μg/kg bolus over 10 min, followed by a 0...
January 16, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28092320/does-a-platelet-transfusion-independently-affect-bleeding-and-adverse-outcomes-in-cardiac-surgery
#11
Fabienne M A van Hout, Esther K Hogervorst, Peter M J Rosseel, Johanna G van der Bom, Mohamed Bentala, Eveline L A van Dorp, Nan van Geloven, Anneke Brand, Nardo J M van der Meer, Leo M G van de Watering
BACKGROUND: Conflicting results have been reported concerning the effect of platelet transfusion on several outcomes. The aim of this study was to assess the independent effect of a single early intraoperative platelet transfusion on bleeding and adverse outcomes in cardiac surgery patients. METHODS: For this observational study, 23,860 cardiac surgery patients were analyzed. Patients who received one early (shortly after cardiopulmonary bypass while still in the operating room) platelet transfusion, and no other transfusions, were defined as the intervention group...
January 16, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28092319/network-inefficiency-a-rosetta-stone-for-the-mechanism-of-anesthetic-induced-unconsciousness
#12
George A Mashour
No abstract text is available yet for this article.
January 16, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28079567/cardiac-calcium-release-channel-ryanodine-receptor-2-regulation-by-halogenated-anesthetics
#13
Derek R Laver, John Attia, Christopher Oldmeadow, Anthony W Quail
BACKGROUND: Halogenated anesthetics activate cardiac ryanodine receptor 2-mediated sarcoplasmic reticulum Ca release, leading to sarcoplasmic reticulum Ca depletion, reduced cardiac function, and providing cell protection against ischemia-reperfusion injury. Anesthetic activation of ryanodine receptor 2 is poorly defined, leaving aspects of the protective mechanism uncertain. METHODS: Ryanodine receptor 2 from the sheep heart was incorporated into artificial lipid bilayers, and their gating properties were measured in response to five halogenated anesthetics...
January 12, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28079566/retesting-the-hypothesis-of-a-clinical-randomized-controlled-trial-in-a-simulation-environment-to-validate-anesthesia-simulation-in-error-research-the-vaser-study
#14
Alan F Merry, Jacqueline A Hannam, Craig S Webster, Kylie-Ellen Edwards, Jane Torrie, Chris Frampton, Daniel W Wheeler, Arun K Gupta, Ravi P Mahajan, Rachel Evley, Jennifer M Weller
BACKGROUND: Simulation has been used to investigate clinical questions in anesthesia, surgery, and related disciplines, but there are few data demonstrating that results apply to clinical settings. We asked "would results of a simulation-based study justify the same principal conclusions as those of a larger clinical study?" METHODS: We compared results from a randomized controlled trial in a simulated environment involving 80 cases at three centers with those from a randomized controlled trial in a clinical environment involving 1,075 cases...
January 12, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28079565/anesthetics-the-ryanodine-receptors-and-the-heart
#15
Ion A Hobai
No abstract text is available yet for this article.
January 12, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28079564/an-anesthesiologist-s-perspective-on-the-history-of-basic-airway-management-the-artisanal-anesthetic-era-1846-to-1904
#16
Adrian A Matioc
This second installment of the history of basic airway management covers the early-artisanal-years of anesthesia from 1846 to 1904. Anesthesia was invented and practiced as a supporting specialty in the context of great surgical and medical advances. The current-day anesthesia provider tends to equate the history of airway management with the history of intubation, but for the first 58 yr after the introduction of ether anesthesia, airway management was provided by basic airway techniques with or without the use of a face mask...
January 12, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28072601/risk-factors-and-clinical-outcomes-associated-with-perioperative-transfusion-associated-circulatory-overload
#17
Leanne Clifford, Qing Jia, Arun Subramanian, Hemang Yadav, Darrell R Schroeder, Daryl J Kor
BACKGROUND: Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. METHODS: In this case-control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications...
January 10, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28072600/adjusting-the-focus-on-transfusion-associated-circulatory-overload
#18
Nareg Roubinian, Edward L Murphy
No abstract text is available yet for this article.
January 10, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28059838/comparison-of-the-prognostic-significance-of-initial-blood-lactate-and-base-deficit-in-trauma-patients
#19
Mathieu Raux, Yannick Le Manach, Tobias Gauss, Romain Baumgarten, Sophie Hamada, Anatole Harrois, Bruno Riou, Jacques Duranteau, Olivier Langeron, Jean Mantz, Catherine Paugam-Burtz, Bernard Vigue
BACKGROUND: Initial blood lactate and base deficit have been shown to be prognostic biomarkers in trauma, but their respective performances have not been compared. METHODS: Blood lactate levels and base deficit were measured at admission in trauma patients in three level 1 trauma centers. This was a retrospective analysis of prospectively acquired data. The association of initial blood lactate and base deficit with mortality was tested using receiver operating characteristics curve, logistic regression using triage scores (Revised Trauma Score and Mechanism Glasgow scale and Arterial Pressure score), and Trauma Related Injury Severity Score as a reference standard...
January 6, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28059837/complications-risk-factors-and-staffing-patterns-for-noncardiac-surgery-in-patients-with-left-ventricular-assist-devices
#20
Michael R Mathis, Subramanian Sathishkumar, Sachin Kheterpal, Matthew D Caldwell, Francis D Pagani, Elizabeth S Jewell, Milo C Engoren
BACKGROUND: Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. METHODS: The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015...
January 6, 2017: Anesthesiology
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