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https://www.readbyqxmd.com/read/28424823/-coma-in-the-emergency-room
#1
M Braun, C J Ploner, T Lindner, M Möckel, W U Schmidt
Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO...
April 19, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28410820/-optimizing-post-operative-pain-management-in-latin-america
#2
João Batista Santos Garcia, Patricia Bonilla, Durval Campos Kraychette, Fernando Cantú Flores, Elizabeth Diaz Perez de Valtolina, Carlos Guerrero
Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and importance of clear policies and guidelines for recording pain intensity, the use of specific analgesics and the proper approach to patient education have led to the consistent under-treatment of pain management in the region...
April 11, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28370989/specialty-based-variations-in-spinal-cord-stimulation-success-rates-for-treatment-of-chronic-pain
#3
Syed Mohammed Qasim Hussaini, Kelly Ryan Murphy, Jing L Han, Aladine A Elsamadicy, Siyun Yang, Alykhan Premji, Beth Parente, Jichun Xie, Promila Pagadala, Shivanand P Lad
OBJECTIVES: Spinal cord stimulation (SCS) has emerged as an appropriate modality of treatment for intractable chronic pain. The present study examines variations in SCS trial-to-permanent conversion rates based on provider types performing the procedure. MATERIALS AND METHODS: We designed a large, retrospective analysis using the Truven MarketScan data base analyzing adult SCS patients with provider information available, with or without IPG implantation from the years 2007-2012...
April 2, 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28243715/volume-replacement-during-trauma-resuscitation-a-brief-synopsis-of-current-guidelines-and-recommendations
#4
REVIEW
M Maegele, M Fröhlich, M Caspers, S Kaske
INTRODUCTION: Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate. METHODS: A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr...
February 27, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28169966/perioperative-management-of-adult-patients-with-external-ventricular-and-lumbar-drains-guidelines-from-the-society-for-neuroscience-in-anesthesiology-and-critical-care
#5
Abhijit V Lele, Amie L Hoefnagel, Nina Schloemerkemper, David A Wyler, Nophanan Chaikittisilpa, Monica S Vavilala, Bhiken I Naik, James H Williams, Lakshmikumar Venkat Raghavan, Ines P Koerner
External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains...
February 6, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28126454/ultrasound-guided-retroclavicular-approach-infraclavicular-brachial-plexus-block-for-upper-extremity-emergency-procedures
#6
Josh Luftig, Daniel Mantuani, Andrew A Herring, Arun Nagdev
The America Society of Anesthesiology guidelines recommend multimodal analgesia that combines regional anesthetic techniques with pharmacotherapy to improve peri-procedural pain management and reduce opioid related complications. Commonly performed emergency procedures of the upper extremity such as fracture and dislocation reduction, wound debridement, and abscess incision and drainage are ideal candidates for ultrasound-guided (USG) regional anesthesia of the brachial plexus. However, adoption of regional anesthesia by emergency practitioners has been limited by concerns for potential complications and perceived technical difficulty...
January 15, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27846126/implementation-of-the-american-society-of-anesthesiology-s-guidelines-to-reduce-prolonged-fasting-times-in-pediatric-preoperative-patients-a-best-practice-implementation-project
#7
Carol M Costello
BACKGROUND: The American Society of Anesthesiology (ASA) guidelines for pediatric preoperative fasting have been a standard for well over a decade. However, use of protocols involving an excessive fasting duration exposes patients to the physiological impacts of fluid volume loss. OBJECTIVES: The current project aimed to improve fluid supplementation during presurgical fasting in pediatric patients at an academic medical center. Specific objectives were to increase clinical staff knowledge regarding ASA fasting standards and implement them in specific pediatric patient populations...
October 2016: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/27787571/-anesthesia-for-medical-students-a-brief-guide-to-practical-anesthesia-in-adults-with-a-web-based-video-illustration
#8
REVIEW
S Mathis, O Schlafer, J Abram, J Kreutziger, P Paal, V Wenzel
In Germany, Austria and Switzerland, anesthesiologists are the second largest group of physicians in hospitals, but this does not correspond to the amount of anesthesiology teaching that medical students receive in medical schools. Accordingly, the chances of medical students recognizing anesthesiology as a promising personal professional career are smaller than in other disciplines with large teaching components. Subsequent difficulties to recruit anesthesiology residents are likely, although many reasons support anesthesiology as a professional career...
December 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27769172/randomized-controlled-trials-vs-observational-studies-why-not-just-live-together
#9
David Faraoni, Simon Thomas Schaefer
Randomized controlled trials (RCTs) are considered the gold standard for clinical research, thus having a high impact on clinical guidelines and our daily patients' care. However, various treatment strategies which we consider "evidence based" have never been subject to a prospective RCT, as we would rate it unethical to withheld an established treatment to individuals in an placebo controlled trial.In a recent BMC Anesthesiology publication, Trentino et al. analyzed the usefulness of observational studies in assessing benefit and risk of different transfusion strategies...
October 21, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27638297/simulation-based-assessment-of-anesthesiology-residents-competence-development-and-implementation-of-the-canadian-national-anesthesiology-simulation-curriculum-cannasc
#10
Michelle Chiu, Jordan Tarshis, Andreas Antoniou, T Laine Bosma, Jessica E Burjorjee, Neil Cowie, Simone Crooks, Kate Doyle, David Dubois, Tobias Everett, Rachel Fisher, Megan Hayter, Genevieve McKinnon, Diana Noseworthy, Noel O'Regan, Greg Peachey, Arnaud Robitaille, Michael Sullivan, Marshall Tenenbein, Marie-Helene Tremblay
The specialty of anesthesiology will soon adopt the Competence By Design (CBD) approach to residency education developed by the Royal College of Physicians and Surgeons of Canada (RCPSC). A foundational component of CBD is frequent and contextualized assessment of trainees. In 2013, the RCPSC Anesthesiology Specialty Committee assembled a group of simulation educators, representing each of the 17 Canadian anesthesiology residency programs, to form the Canadian National Anesthesiology Simulation Curriculum (CanNASC) Task Force...
December 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/27581549/a-retrospective-observational-study-of-anesthetic-induction-dosing-practices-in-female-elderly-surgical-patients-are-we-overdosing-older-patients
#11
Shamsuddin Akhtar, Joseph Heng, Feng Dai, Robert B Schonberger, Mathew M Burg
BACKGROUND/OBJECTIVES: Despite guidelines suggesting a 25-50 % reduction in induction doses of intravenous anesthetic agents in the elderly (≥65 years), we hypothesized that practitioners were not sufficiently correcting drug administration for age, contributing to an increased incidence of hypotension in older patients undergoing general anesthesia. STUDY DESIGN: We conducted a retrospective, observational study in a tertiary-care academic hospital. The study included 768 female patients undergoing gynecologic surgeries who received propofol-based induction of general anesthesia...
August 31, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27537925/publication-bias-and-nonreporting-found-in-majority-of-systematic-reviews-and-meta-analyses-in-anesthesiology-journals
#12
Riley J Hedin, Blake A Umberham, Byron N Detweiler, Lauren Kollmorgen, Matt Vassar
BACKGROUND: Systematic reviews and meta-analyses are used by clinicians to derive treatment guidelines and make resource allocation decisions in anesthesiology. One cause for concern with such reviews is the possibility that results from unpublished trials are not represented in the review findings or data synthesis. This problem, known as publication bias, results when studies reporting statistically nonsignificant findings are left unpublished and, therefore, not included in meta-analyses when estimating a pooled treatment effect...
October 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27533913/pain-management-for-blunt-thoracic-trauma-a-joint-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma-and-trauma-anesthesiology-society
#13
Samuel Michael Galvagno, Charles E Smith, Albert J Varon, Erik A Hasenboehler, Shahnaz Sultan, Gregory Shaefer, Kathleen B To, Adam D Fox, Darrell E R Alley, Michael Ditillo, Bellal A Joseph, Bryce R H Robinson, Elliot R Haut
INTRODUCTION: Thoracic trauma is the second most prevalent nonintentional injury in the United States and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework recently adopted by EAST are presented...
November 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27522950/adverse-event-reporting-in-clinical-trials-of-intravenous-and-invasive-pain-treatments-an-acttion-systematic-review
#14
REVIEW
Mark R Williams, Andrew McKeown, Zachary Pressman, Matthew Hunsinger, Kendrick Lee, Paul Coplan, Ian Gilron, Nathaniel P Katz, Michael P McDermott, Srinivasa N Raja, Bob A Rappaport, Michael C Rowbotham, Dennis C Turk, Robert H Dworkin, Shannon M Smith
Thorough assessment and reporting of adverse events (AEs) facilitates a detailed understanding of a treatment's risk-benefit profile. Although the Consolidated Standards of Reporting Trials (CONSORT) 2004 statement provides recommendations regarding AE reporting, adherence to these standards is often inadequate. We investigated AE reporting in clinical trials of intravenous and invasive pain treatments published in 6 major anesthesiology and pain journals between 2000 to 2003 and 2006 to 2012. We examined whether AE reporting improved after publication of the 2004 CONSORT recommendations and also comprehensively reviewed AE assessment using the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) AE reporting recommendations...
November 2016: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/27479264/-graduate-medical-education-structured-competency-based-training-in-anesthesiology
#15
Klaus Hahnenkamp, Markus Wenning
The "Joint Commission of BDA and DGAI for Graduate Medical Education and Further Education" presents a concept for postgraduate training in anesthesiology. Aiming at a different and demanding generation of young physicians it proposes a new approach to an attractive training in anesthesiology e. g. by simulation as one key concept. It is also intended to meet the guidelines of the German Medical Association of competency based rather than time based or procedure based graduate medical education. A clear structure and the competency based approach shall facilitate a process of professional teaching...
July 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27479258/-cardiac-evaluation-before-non-cardiac-surgery
#16
Jan Menzenbach, Olaf Boehm
Before non-cardiac surgery, evaluation of cardiac function is no frequent part of surgical treatment. European societies of anesthesiology and cardiology published consensus-guidelines in 2014 to present a reasonable approach for preoperative evaluation. This paper intends to differentiate the composite of perioperative risk and to display the guidelines methodical approach to handle it. Features to identify patients at risk from an ageing population with comorbidities, are the classification of surgical risk, functional capacity and risk indices...
July 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27461766/current-practice-of-acute-pain-management-in-children-a-national-follow-up-survey-in-germany
#17
Miriam I Emons, Frank Petzke, Ulrike M Stamer, Winfried Meißner, Regina Koschwitz, Joachim Erlenwein
OBJECTIVES: This study aimed to summarize the current standard practices for acute pain management in children in Germany and the implementation of these procedures. The last survey on acute pain management in children was performed in 1999, highlighting the need for an up to date review. METHODS: A questionnaire was mailed to German departments of anesthesiology (n = 885), asking for structures and processes of acute pain management in children. Results were compared between hospitals with and without an acute pain service and with and without a pediatric department...
September 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27434480/management-of-obstructive-sleep-apnea-in-children-a-practical-approach
#18
Kevin D Pereira, Cindy K Jon, Peter Szmuk, Rande H Lazar, Ron B Mitchell
The management of sleep disordered breathing (SDB) in children differs between institutions, and there is a need for an updated review of current practice. Literature was reviewed using the PubMed database from 1995 to 2015 by four tertiary care providers experienced in the management of children with SDB. Articles were selected for clinical applicability, strength of evidence, and practicality for practicing clinicians. Fifty-five articles were identified by tertiary care providers in pediatric anesthesiology, pediatric pulmonology, sleep medicine, and pediatric otolaryngology...
July 2016: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/27379593/the-association-of-shelter-veterinarians-2016-veterinary-medical-care-guidelines-for-spay-neuter-programs
#19
Brenda Griffin, Philip A Bushby, Emily McCobb, Sara C White, Y Karla Rigdon-Brestle, Leslie D Appel, Kathleen V Makolinski, Christine L Wilford, Mark W Bohling, Susan M Eddlestone, Kelly A Farrell, Nancy Ferguson, Kelly Harrison, Lisa M Howe, Natalie M Isaza, Julie K Levy, Andrea Looney, Michael R Moyer, Sheilah Ann Robertson, Kathy Tyson
As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners...
July 15, 2016: Journal of the American Veterinary Medical Association
https://www.readbyqxmd.com/read/27357590/sudden-death-after-major-head-and-neck-cancer-surgery-due-to-undetected-arrhythmogenic-right-ventricle-cardiomyopathy-arvc
#20
Ákos Bicsák, Alice Jellen, Herwig Tuppy, Wolfgang Paul Poeschl
BACKGROUND: Oral squamous cell carcinoma is the sixth most frequent malignancy in Austria. The incidence of arrhythmogenic right ventricle dysplasia (ARVC), an important cause of sudden cardiac death, is estimated at 1:5000 to 1:1000. CASE REPORT: We present a case of a 75-year-old woman who underwent major oncologic surgery for T4aN0M0 maxillary squamous cell carcinoma and reconstruction with a scapular-latissimus dorsi microvascular flap. The patient died suddenly during her postoperative care...
June 29, 2016: Oral and Maxillofacial Surgery
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