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critical care anesthesia

Flavia Petrini, Ida Di Giacinto, Rita Cataldo, Clelia Esposito, Vittorio Pavoni, Paolo Donato, Antonella Trolio, Guido Merli, Massimiliano Sorbello, Paolo Pelosi
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose body mass index is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population...
October 19, 2016: Minerva Anestesiologica
Hüseyin Ulaş Pınar, Omer Karaca, Rafi Doğan, Ümmü Mine Konuk
BACKGROUND: Smartphones are used in many areas of anesthesia practice. However, recent editorial articles have expressed concerns about smartphone uses in the operating room for non-medical purposes. We performed a survey to learn about the smartphone use habits and views of Turkish anesthesia providers. METHODS: A questionnaire consisting of 14 questions about smartphone use habits during anesthesia care was sent anesthesia providers. RESULTS: In November-December 2015, a total of 955 participants answered our survey with 93...
October 6, 2016: BMC Anesthesiology
P Marshall-Brown, F Namboya, G Pollach
STUDY OBJECTIVE: This study aimed to evaluate whether (regarding the Surviving Sepsis Campaign [SSC] guidelines) the training of Malawis scarce medical staff is adequate. Hospitals in Malawi have a severe shortage of human resources and therefore rely heavily on junior staff. Sepsis is a leading cause of admission to hospitals particularly in resource poor countries. It is associated with a high mortality rate. The SSC guidelines have been developed to help frontline staff diagnose and treat patients with sepsis...
November 2016: Journal of Clinical Anesthesia
Eun Jung Kim, Sarah Soh, So Yeon Kim, Hae Keum Kil, Jae Hoon Lee, Jeong Min Kim, Tae Whan Kim, Bon-Nyeo Koo
Background: Endothelial dysfunction associated with diabetes mellitus (DM) may influence arterial vasoreactivity after arterial stimulus, such as cannulation, and cause changes in diameter and blood flow. Despite the frequent use of arterial cannulation during anesthesia and critical care, little information is available regarding vasoreactivity of the radial and ulnar arteries and its influence on underlying DM. Methods: Forty non-DM and 40 DM patients, who required arterial cannulation during general anesthesia, were enrolled...
2016: International Journal of Medical Sciences
David Schnell, Elie Azoulay, Dominique Benoit, Benjamin Clouzeau, Pierre Demaret, Stéphane Ducassou, Pierre Frange, Matthieu Lafaurie, Matthieu Legrand, Anne-Pascale Meert, Djamel Mokart, Jérôme Naudin, Frédéric Pene, Antoine Rabbat, Emmanuel Raffoux, Patricia Ribaud, Jean-Christophe Richard, François Vincent, Jean-Ralph Zahar, Michael Darmon
Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society...
December 2016: Annals of Intensive Care
Katy E French, Alexis B Guzman, Augustin C Rubio, John C Frenzel, Thomas W Feeley
BACKGROUND: With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of 11 common oncologic outpatient surgical procedures. METHODS: Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures...
September 2016: Healthcare
Shravya Govindappagari, Amanda Guardado, Dena Goffman, Jeffrey Bernstein, Colleen Lee, Sara Schonfeld, Robert Angert, Andrea McGowan, Peter S Bernstein
OBJECTIVE: Communication failures are consistently seen as a root cause of preventable adverse outcomes in obstetrics. We assessed whether use of an Obstetric Safe Surgery Checklist for cesarean deliveries (CDs), based on the WHO Safe Surgery Checklist, can improve communication; reduce team member confusion about urgency of the case; and decrease documentation discrepancies among nursing, obstetric, anesthesia, and pediatric staff. METHODS: Retrospective review of 600 CDs on our 2 labor and delivery suites before and after the introduction of 2 consecutive versions of our obstetric safe surgery checklist (100 cases in each cohort) was undertaken...
September 8, 2016: Journal of Patient Safety
Helge Eilers
No abstract text is available yet for this article.
September 6, 2016: Liver Transplantation
P Niclas Broer, Hillary E Jenny, Joshua S Ng-Kamstra, Sabrina Juran
In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment...
May 2016: World Journal of Plastic Surgery
Ilaria Campo, Maurizio Luisetti, Matthias Griese, Bruce C Trapnell, Francesco Bonella, Jan Grutters, Koh Nakata, Coline H M Van Moorsel, Ulrich Costabel, Vincent Cottin, Toshio Ichiwata, Yoshikazu Inoue, Antonio Braschi, Giacomo Bonizzoni, Giorgio A Iotti, Carmine Tinelli, Giuseppe Rodi
BACKGROUND: Whole lung lavage (WLL) is the current standard of care treatment for patients affected by pulmonary alveolar proteinosis (PAP). However, WLL is not standardized and international consensus documents are lacking. Our aim was to obtain a factual portrayal of WLL as currently practiced with respect to the procedure, indications for its use, evaluation of therapeutic benefit and complication rate. METHODS: A clinical practice survey was conducted globally by means of a questionnaire and included 27 centers performing WLL in pediatric and/or adult PAP patients...
2016: Orphanet Journal of Rare Diseases
Andreas Klausen, Rainer Röhrig, Myriam Lipprandt
Achieving a good understanding of the socio-technical system in critical or emergency situations is important for patient safety. Research in human-computer interaction in the field of anesthesia or surgery has the potential to improve usability of the user interfaces and enhance patient safety. Therefore eye-tracking is a technology for analyzing gaze patterns. It can also measure what is being perceived by the physician during medical procedures. The aim of this review is the applicability of eye-tracker in the domain of simulated or real environments of anesthesia, surgery or intensive care...
2016: Studies in Health Technology and Informatics
Monica Loureiro Santos, Cristiane de Oliveira Novaes, Antonio Carlos Iglesias
OBJECTIVE: Assess the demographic and clinical characteristics of surgical patients seen in the Pre-anesthetic Assessment Clinic of the Hospital Universitário Gaffrée e Guinle (APA/HUGG), in order to assist in the pursuit for quality, effectiveness, and resource rationalization of hospital management. METHOD: Cross-sectional descriptive study with 491 patients undergoing elective surgery, treated at APA/HUGG Clinic from March to December 2014. The following variables were assessed: sex, age, BMI, smoking, associated diseases, classification of MET's and ASA, decompensated disease, medical interconsultation, specialty and surgical size, history of prior anesthetic-surgical procedure, and complications...
August 26, 2016: Revista Brasileira de Anestesiologia
Yolanda Y Huang, Lucy Li, Matthew Monteleone, Lynne Ferrari, Lisa J States, James J Riviello, Steven G Kernie, Ali A Mencin, Sumit Gupta, Lena S Sun
Ongoing investigation from the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) study hopes to examine the long-term effect on cognitive and language development of a single anesthetic exposure in children undergoing inguinal hernia repair. The fifth PANDA Symposium, held in April 2016, continued the mission of previous symposia to examine evidence from basic science and clinical studies on potential neurotoxic effects of anesthetics on developing brain. At the 2016 Symposium, a panel of specialists from nonsurgical pediatric disciplines including anesthesiology, radiology, neurology, gastroenterology, oncology, cardiology, and critical care reviewed use of anesthesia in their practices, including how concern over possible neurodevelopmental effects of early childhood anesthetic exposure has changed discussion with patients and families regarding risks and benefits of imaging studies and interventional procedures involving sedation or anesthesia...
August 25, 2016: Journal of Neurosurgical Anesthesiology
Ruchika Goel, Melissa M Cushing, Aaron A R Tobian
Red blood cell transfusions are a common life-saving intervention for neonates and children with anemia, but transfusion decisions, indications, and doses in neonates and children are different from those of adults. Patient blood management (PBM) programs are designed to assist clinicians with appropriately transfusing patients. Although PBM programs are well recognized and appreciated in the adult setting, they are quite far from standard of care in the pediatric patient population. Adult PBM standards cannot be uniformly applied to children, and there currently is significant variation in transfusion practices...
October 2016: Transfusion Medicine Reviews
Zeljko J Bosnjak, Sarah Logan, Yanan Liu, Xiaowen Bai
Mounting evidence has demonstrated that general anesthetics could induce developmental neurotoxicity, including acute widespread neuronal cell death, followed by long-term memory and learning abnormalities. Propofol is a commonly used intravenous anesthetic agent for the induction and maintenance of anesthesia and procedural and critical care sedation in children. Compared with other anesthetic drugs, little information is available on its potential contributions to neurotoxicity. Growing evidence from multiple experimental models showed a similar neurotoxic effect of propofol as observed in other anesthetic drugs, raising serious concerns regarding pediatric propofol anesthesia...
November 2016: Anesthesia and Analgesia
Alexander J Doyle, Daniel Stolady, Maryanne Mariyaselvam, Gayathri Wijewardena, Emma Gent, Mark Blunt, Peter Young
PURPOSE: Hypoxia is one of the leading causes of anesthesia-related injury. In response to the limitations of conventional preoxygenation, Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) has been used as a method of providing both preoxygenation and apneic oxygenation during intubation. MATERIALS AND METHODS: In this prospective, observational study, THRIVE was introduced in a critical care unit (CCU), operating room (OR), and emergency department (ED) during emergency intubation of patients at high risk of hypoxia...
June 23, 2016: Journal of Critical Care
Sara N Goldhaber-Fiebert, Justin Pollock, Steven K Howard, Sylvia Bereknyei Merrell
BACKGROUND: Emergency manuals (EMs), context-relevant sets of cognitive aids or crisis checklists, have been used in high-hazard industries for decades, although this is a nascent field in health care. In the fall of 2012, Stanford clinically implemented EMs, including hanging physical copies in all Stanford operating rooms (ORs) and training OR clinicians on the use of, and rationale for, EMs. Although simulation studies have shown the effectiveness of EMs and similar tools when used by OR teams during crises, there are little data on clinical implementations and uses...
September 2016: Anesthesia and Analgesia
William M Armstead
This article provides a review of cerebral autoregulation, particularly as it relates to the clinician scientist experienced in neuroscience in anesthesia and critical care. Topics covered are biological mechanisms; methods used for assessment of autoregulation; effects of anesthetics; role in control of cerebral hemodynamics in health and disease; and emerging areas, such as role of age and sex in contribution to dysautoregulation. Emphasis is placed on bidirectional translational research wherein the clinical informs the study design of basic science studies, which, in turn, informs the clinical to result in development of improved therapies for treatment of central nervous system conditions...
September 2016: Anesthesiology Clinics
Viviane G Nasr, James A DiNardo
OBJECTIVES: This review will focus on the pharmacokinetics (with an emphasis on the context-sensitive half-time), pharmacodynamics, and hemodynamic characteristics of the most commonly used sedative/hypnotic, analgesic, and IV anesthetics used in cardiac intensive care. In addition, the assessment of pain and agitation and withdrawal will be reviewed. DATA SOURCE: MEDLINE, PubMed. CONCLUSIONS: Children in the cardiac ICU often require one or more components of general anesthesia: analgesia, amnesia (sedation and hypnosis), and muscle relaxation to facilitate mechanical ventilation, to manage postoperative pain, to perform necessary procedures, and to alleviate fear and anxiety...
August 2016: Pediatric Critical Care Medicine
Yiorgos Alexandros Cavayas, Martin Girard, Georges Desjardins, André Y Denault
BACKGROUND: Acute deterioration in respiratory status commonly occurs in patients who cannot be transported for imaging studies, particularly during surgical procedures and in critical care settings. Transthoracic lung ultrasonography has been developed to allow rapid diagnosis of respiratory conditions at the bedside. Nevertheless, the thorax is not always accessible, especially in the perioperative setting. Transesophageal lung ultrasonography (TELU) can be used to circumvent this problem...
November 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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