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David A Watters, Glenn D Guest, Viliami Tangi, Mark G Shrime, John G Meara
Progress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery...
April 2018: Anesthesia and Analgesia
Muralidhar Pai K, R Chandrasekhar Naidu, A Raja, Y S Rai, Niranjan Kumar, Anand Kini, Santhosh Joseph, Vinod Hegde, H S Ballal, Ramoorthi Rao, Saroja V Sharma, Vinay Kumar Valakatte
Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis...
March 2018: Neurology India
James A Crowhurst, Gregory M Scalia, Mark Whitby, Dale Murdoch, Brendan J Robinson, Arianwen Turner, Liesie Johnston, Swaroop Margale, Sarvesh Natani, Andrew Clarke, Darryl J Burstow, Owen C Raffel, Darren L Walters
BACKGROUND: Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation. OBJECTIVES: This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention. METHODS: Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support...
March 20, 2018: Journal of the American College of Cardiology
Georges Mion, Didier Journois, Nicolas Libert
No abstract text is available yet for this article.
March 14, 2018: Anesthesia and Analgesia
Peter Anders Christensen
Austere care of the wounded is challenging for all Western medical professionals-nurse, medic, or physician. There can be no doubt that working for the first time, either for a nongovernment organization or in the Special Forces, you will be taking care of wounded patients outside your training and experience. You must have the ability to adapt to and overcome lack of resources and equipment, and accept standards of treatment often very different and lower than that common in western hospitals. The International Committee of the Red Cross (ICRC) was asked to provide relief for the Pakistan Red Crescent in 1982 and set up the ICRC Hospital for Afghan War Wounded in Peshawar on the border to Afghanistan...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Manuel F Struck, Sebastian Ewens, Wolfram Schummer, Thilo Busch, Michael Bernhard, Johannes K M Fakler, Patrick Stumpp, Sebastian N Stehr, Christoph Josten, Hermann Wrigge
PURPOSE: Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. METHODS: Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015...
March 1, 2018: Journal of Vascular Access
Andrew F Cumpstey, Jim S Milledge, Michael P W Grocott
No abstract text is available yet for this article.
2018: International Anesthesiology Clinics
Andrew S Young, Michael W Fischer, Nicholas S Lang, Matthew R Cooke
This study provides trends in the discipline of dental anesthesiology. A questionnaire-based survey was sent to 338 members of the American Society of Dentist Anesthesiologists to evaluate practice patterns. One focus of the study was modality of sedation/anesthesia used for dentistry in North America. Age, gender, years in practice, and geographic region of practice were also obtained. Data gathered from the returned questionnaires were entered into an Excel spreadsheet and then imported into JMP Statistical Discovery Software (v12...
2018: Anesthesia Progress
M N Bergold, H Beeck, D Meininger, C Byhahn
An important challenge in learning ultrasound-assisted interventions, such as pericardiocentesis, is the navigation of the needle in a three-dimensional space on the basis of a two-dimensional image. In order to learn this in vitro realistic simulators are required. We manufactured a model which allows simulation of pericardiocentesis on the basis of ballistic gelatin (12.6%, 250 Bloom). Furthermore, the pericardiocentesis model was subjectively evaluated by 37 anesthetists in a pre-post design. The models used proved to be technically simple to manufacture, hard wearing and realistic...
March 2, 2018: Der Anaesthesist
Sandeep Grover, Pooja Sikka, Shiv Sajan Saini, Neeru Sahni, Subho Chakrabarti, Devakshi Dua, Anisha Aggarwal, Anita Thakur, Shallu Dhiman, Amal Jolly, Swapnajeet Sahoo, Aseem Mehra, Aditya Somani
There is limited literature on the use of electroconvulsive therapy (ECT) during pregnancy. ECT is considered as a treatment of last resort during pregnancy. In this case series, we present the data of five patients who were administered ECT during pregnancy. The use of ECT required multidisciplinary approach involving psychiatrist, gynecologist, anesthetist and neonatologist. Two patients received ECT during the second trimester and three patients received ECT during the third trimester. In all the patients, ECT was administered by placing the patients in the left lateral position, glycopyrrolate was used for premedication, thiopentone was used for induction, and succinylcholine was used for muscle relaxation...
October 2017: Indian Journal of Psychiatry
M J Harris, R A Gabriel, R P Dutton, R D Urman
INTRODUCTION: Accurately predicting cesarean delivery case duration is an integral component of designing appropriate workflow protocols and ensuring adequate provider availability. Our primary objective was to describe the variability of case duration, based on factors that we hypothesized would be influential, such as hospital facility type, United States region, time of day, case volume, and patient and provider characteristics. METHODS: We analyzed hospital-, patient-, and provider-level variables from the National Anesthesia Clinical Outcomes Registry, a voluntary registry created to share anesthesia-related data and outcomes...
January 13, 2018: International Journal of Obstetric Anesthesia
N'Diris Barry, Joshua C Uffman, Dmitry Tumin, Joseph D Tobias
OBJECTIVES: Neuromuscular blocking agents (NMBAs) are administered to facilitate endotracheal intubation and provide skeletal muscle relaxation in surgical procedures. Sugammadex (Bridion) recently received approval by the United States Food and Drug Administration for reversal of rocuronium and vecuronium-induced neuromuscular blockade thereby providing an alternative to acetylcholinesterase inhibitors such as neostigmine. This quality improvement analysis sought to investigate the clinical reasons and common clinical perceptions for choosing sugammadex over neostigmine to reverse NMBAs...
January 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Michael T Froehler, Rohan Chitale, Jordan A Magarik, Matthew R Fusco
PURPOSE: The efficiency of neuroendovascular procedures may partly depend on the time devoted to placement of a radial arterial line (RAL) for intraoperative blood pressure monitoring. An alternative approach is to use a pressure-sensing sheath (PSS) that serves to provide invasive blood pressure monitoring without requiring a separate procedure for placement. We compared the use of a RAL versus PSS and assessed procedure time, anesthetist and patient satisfaction, and cost. METHODS: We performed a single-center, prospective, blockwise, comparative trial of procedure start time using traditional RAL placement versus the EndoPhys PSS for invasive blood pressure monitoring...
February 27, 2018: Journal of Neurointerventional Surgery
Qiong Ling, Yu Gu, Jiaxin Chen, Yansheng Chen, Yongyong Shi, Gaofeng Zhao, Qianqian Zhu
BACKGROUND: Patients who use angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) are prone to developing side effects like hypotension and even refractory hypotension during anesthesia use, and whether ACEIs/ARBs should be continued or discontinued in such patients remains debatable. The present systematic review and meta-analysis was conducted to clarify the consequences of continuing or withholding these drugs, especially with regards to the incidence of intraoperative hypotension, in patients who continue to use ACEIs/ARBs on the day of their scheduled surgery...
February 26, 2018: BMC Anesthesiology
Tong Qiu, Baohua Yu, Yunpeng Xuan, Haihong Luan, Wenjie Jiao
We describe a novel method using electromagnetic navigation bronchoscopy (ENB) without dye marking to perform vectorial localization for an impalpable peripheral lesion in the right lower lobe during diagnostic surgical resection in a 52-year-old woman. After the ENB registration process, the anesthetist changed the single-lumen endotracheal tube to a double-lumen endobronchial tube. Guided by the ENB system, the operator delivered the probe of the locatable guide to the planned site through the right lumen of the endobronchial tube...
February 23, 2018: Thoracic Cancer
Cristina López Muñoz, Andrés Sánchez Yagüe, Jose Carlos Canca Sánchez, José Antonio Reinaldo-Lapuerta, Ana Belén Moya Suárez
INTRODUCTION: research has shown that an endoscopist-nurse clinical team can perform sedation with propofol effectively, safely and efficiently. To do so, it is essential to provide specific and appropriate training in the necessary skills. The main aim of the present study was to evaluate the quality of the sedation procedure administered by non-anesthetists in a digestive endoscopy unit, one year after its introduction. METHODS: a prospective cohort study was performed in patients given propofol sedation by non-anesthetists...
February 21, 2018: Revista Española de Enfermedades Digestivas
Leopoldo López Rosés, Beatriz Álvarez, Abel González Ramírez, Alina López Baz, Alexia Fernández López, Sara Alonso, Andrés Dacal, Eva Martí, Gino Albines, Julieta Fernández Molina, Ángel Lancho
INTRODUCTION: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. MATERIAL AND METHOD: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration...
February 21, 2018: Revista Española de Enfermedades Digestivas
Federico Piccioni, Riccardo Ragazzi
Enhanced recovery after surgery (ERAS) programs are developed to prevent factors that delay postoperative recovery as well as issues that cause complications. The development of video-assist thoracoscopic surgery (VATS) techniques favors the fast recovery after thoracic procedures. ERAS strategies are based on multidisciplinary approach in which the anesthetist plays an important role from the preoperative to the postoperative phase with several goals. After preoperative evaluation and medical optimization, the anesthetist must ensure a tailored anesthetic plan aiming to a fast recovery and adequate pain relief to reduce the response to the surgical stress...
2018: Journal of visualized surgery
Hassan Soleimanpour, Saeid Safari, Sarvin Sanaie, Mehdi Nazari, Seyed Moayed Alavian
Context: This article discusses the anesthetic considerations in patients undergoing bariatric surgery in the preoperative, intraoperative, and postoperative phases of surgery. Evidence Acquisition: This review includes studies involving obese patients undergoing bariatric surgery. Searches have been conducted in PubMed, MEDLINE, EMBASE, Google Scholar, Scopus, and Cochrane Database of Systematic Review using the terms obese, obesity, bariatric, anesthesia, perioperative, preoperative, perioperative, postoperative, and their combinations...
August 2017: Anesthesiology and Pain Medicine
Juan Duchesne, Chad Majoue, Marquinn Duke, Rosemarie Robledo, Chad Achord, Leslie McHale, Brandy Davis, Lusine Nahapetyan
A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS)...
January 1, 2018: American Surgeon
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