Anesthesia

Avoidance of excessively deep sedation levels is problematic in intensive care patients. Electrophysiologic monitoring may offer an approach to solving this problem. Since electroencephalogram (EEG) responses to different sedation regimens vary, we assessed electrophysiologic responses to two sedative drug regimens in 10 healthy volunteers. Dexmedetomidine/remifentanil (dex/remi group) and midazolam/remifentanil (mida/remi group) were infused 7 days apart. Each combination of medications was given at stepwise intervals to reach Ramsay scores (RS) 2, 3, and 4. Resting EEG, bispectral index (BIS), and the N100 amplitudes of long-latency auditory-evoked potentials (ERP) were recorded at each level of sedation. During dex/remi, resting EEG was characterized by a recurrent highpower low-frequency pattern which became more pronounced at deeper levels of sedation. BIS Index decreased uniformly in only the dex/remi group (from 94 Ϯ 3 at baseline to 58 Ϯ 14 at RS 4) compared to the mida/remi group (from 94 Ϯ 2 to 76 Ϯ 10; P ϭ 0.029 between groups). The ERP amplitudes decreased from 5.3 Ϯ 1.3 at baseline to 0.4 Ϯ 1.1 at RS 4 (P ϭ 0.003) in only the mida/remi group. We conclude that ERPs in volunteers sedated with dex/remi, in contrast to mida/remi, indicate a cortical response to acoustic stimuli, even when sedation reaches deeper levels. Consequently, ERP can monitor sedation with midazolam but not with dexmedetomidine. The reverse is true for BIS.

Background: Perioperative pain after abdominal surgery is difficult to manage. Despite the advent of multimodal analgesia techniques, the opioids remain the cornerstone of treatment. Since the opioids' adverse effects are of concern immediate postoperatively, music as a modality that would influence human behavior, is of interest as an adjunct for acute pain management. Our hypothesis was that listening to instrumental music during the perioperative period reduces the pain level and decreases the use of opioids within the first 23 hours after the surgery. Methods: The study was designed as randomized clinical trial, including 54 males who underwent abdominal surgery under general anesthesia. One group was allocated to music therapy intra and postoperatively (G1), and the other was the control group (G2), without music therapy. The statistical analysis for each of the response variable, blood pressure, heart rate, oxygen saturation, visual analogue scale (VAS) score and morphine equivalents (ME), was based on a linear regression analysis accounting for group and time differences and adjusting for covariates (age, height, weight) if necessary (statistically significant). Results: Our study results show a statistically significant difference regarding the mean VAS measurements between the two groups before and after music therapy on arrival in the Postanesthesia Care Unit (PACU) [ 2.4; CI 95% 1.39-3.35 versus 4.1 CI 95% 2.77-5.53], 30 minutes [ 3; CI95% 2.21-3.87 vs 5.48; CI95% 4.34-6.62] and 23 hours later [2.15; CI95% 1.38-2.91 vs 4.37;CI 95% 3.51-5.24] , respectively (Table 2). There was no statistically significant difference in blood pressure (systolic and diastolic), heart rate, oxygen saturation (SpO2), and opioid consumption between the two groups at the three points in time when measurements were done. Conclusions: In this study, a short perioperative exposure to music was effective in reducing the pain perception (as measured by VAS method) but not the opioid consumption in the first 23 hours in male patients after abdominal surgery.

Background Despite the growing interest in dexmedetomidine as an adjunct to truncal blocks, little is known about the systemic absorption of dexmedetomidine after these blocks and its role in analgesia and in hemodynamics. Objective We investigated the pharmacokinetics and pharmacodynamics of dexmedetomidine as an adjunct to transversus abdominis plane (TAP) block in patients undergoing lower abdominal cancer surgery. Methods Twenty-four adult patients were randomized to receive a bilateral single-injection TAP block before surgery with 20 mL of bupivacaine 0.5% (TAP group, n = 12) or combined with 1 µg/kg dexmedetomidine (TAP-DEX group, n = 12) and diluted with saline to a volume of 40 mL (20 mL on each side). Plasma concentrations of dexmedetomidine and its pharmacokinetics were investigated using non-compartmental methods, postoperative analgesia, hemodynamics, and adverse events (nausea, vomiting, itching, hypotension, bradycardia, and respiratory depression). Results Dexmedetom...

Background. Conventional pulmonary artery banding (CPAB) is associated with high morbidity and mortality. We studied the changes in outcome with the use of an adjustable pulmonary artery band (APAB). Methods. Between June 2001 and June 2006, 147 patients underwent PAB: 91 underwent CPAB and 56 underwent APAB. Results. The clinical profile of patients was similar in both groups. Inotropic drugs were used in 91 (100%) patients in the CPAB group and in 12 (21%) in the APAB group (p < 0.001). Early band related reoperation was required in 17 patients in the CPAB group compared with 2 patients in the APAB group (p ‫؍‬ 0.014). There were 21 (23%) early deaths in CPAB group compared with 1 (1.8%) in the APAB group (p < 0.001). There was no difference in the intensive care unit stay, hospital stay, and final band gradients in the two groups. On a mean follow-up of 22.8 ؎ 18.6 months (range, 4 to 72 months), there was PA distortion in 6 patients and band-migration in 4 patients in the CPAB group. These were not observed in the APAB group. Conclusions. Similar band gradients were achieved with the use of conventional or adjustable PAB. However, the use of this simple and inexpensive technique of APAB was associated with a significant reduction in the early band-related deaths, need for early multiple reoperations, and early adverse acute events, thus making it a safer alternative to CPAB, more so in unstable patients.

Background. The aim of this study was to explore difficulties at work from anaesthetists' own perspective and to examine how anaesthetists handle and cope with situations that are perceived as difficult and potentially stressful. Methods. Two sets of interviews were conducted with 19 specialist anaesthetists in Sweden. The first set of interviews aimed at finding how the anaesthetists experienced difficulties at work. It consisted of in-depth interviews based on one open-ended question. We analysed the interviews with a phenomenological method, looking for themes in anaesthetists' descriptions of difficulties at work. In the second set, the interviews were semi-structured with open-ended questions, based on themes found in the first interview set. These interviews aimed at exploring how the interviewees described their ways of handling difficulties and how they coped with potentially stressful situations. Results. Analysis of the first set of interviews resulted in five themes, describing how the anaesthetists experienced difficulties at work. All interviewees talked about difficulties related to more than one of the themes. The second set of interviews revealed two main categories of ways of handling difficulties. First, problem solving consisted of descriptions of methods for handling difficult situations which aimed at solving problems, and second, coping strategies described ways of appraising potentially stressful situations that minimized stress, despite the problem not being solved. Conclusions. The anaesthetists interviewed in this study maintained that they enjoyed work and could see no external obstacles to doing a good job. They had arrived at a reconciliation of their work with its inherent difficulties and problems. Getting access to their coping strategies might help young anaesthetists to come to terms with their work.

Traumatic brain injury (TBI) remains a major cause of morbidity and mortality, particularly in young people. Despite encouraging animal studies, human trials assessing the use of pharmacological agents after TBI have all failed to show efficacy. Current management strategies are therefore directed towards providing an optimal physiological environment in order to minimize secondary insults and maximize the body's own regenerative processes. Modern neurocritical care management utilizes a host of monitoring techniques to identify or predict the occurrence of secondary insults and guide subsequent therapeutic interventions in an attempt to minimize the resulting secondary injury. Recent data suggest that the use of protocolized management strategies, informed by multimodality monitoring, can improve patient outcome after TBI. Developments in multimodality monitoring have allowed a movement away from rigid physiological target setting towards an individually tailored, patient-specific, approach. The wealth of monitoring information available provides a challenge in terms of data integration and accessibility and modern software applications may aid this process. 2007; 99: 61-7

and preparation in relation to patients with deseases affecting the central nervous system. Those patients may undergo various forms of surgery unrelated to the central nervous system disease. We discuss the effect of physiologic and pharmacological factors on cerebral autoregulation and control of intracranial pressure alongside its clinical relevance with the help of new evidence. Recent findings: Regardless of the reason for surgery, coexisting diseases of brain often have important implications when selecting anesthetic drugs, procedures and monitoring techniques. Suppression of cerebral metabolic rate is not the sole mechanism for the neuroprotective effect of anaesthetic agents. There are certain general principles, but also some specific circumstances, when we are talking about optimal anesthetic procedure for a patient with coexisting brain disease. . Summary: Intraoperative cerebral autoregulation monitoring is an important consideration for the patients with coexisting neurological disease. Transcranial Doppler based static autoregulation measurements appears to be the most robust bedside method for this purpose.

Long-range corticocortical communication may have important roles in context-dependent sensory processing, yet we know very little about how these pathways influence their target regions. We studied the influence of primary motor cortex activity on primary somatosensory cortex in the mouse whisker system. We show that primary motor and somatosensory cortices undergo coherent, context-dependent changes in network state. Moreover, we show that motor cortex activity can drive changes in somatosensory cortex network state. A series of experiments demonstrate the involvement of the direct corticocortical feedback pathway, providing temporally precise and spatially targeted modulation of network dynamics. Cortically mediated changes in network state significantly impact sensory coding, with activated states increasing the reliability of responses to complex stimuli. By influencing network state, corticocortical communication from motor cortex may ensure that during active exploration the relevant sensory region is primed for enhanced sensory discrimination.

Anticoagulation therapy for cardiopulmonary bypass in patients with recently diagnosed heparin-induced thrombocytopenia can be particularly challenging. Although heparin is the standard of care, in these situations anticoagulation is achieved with alternative agents such as direct thrombin inhibitors. Therapeutic concentrations are difficult to assess with direct thrombin inhibitors, and their use is riddled with bleeding and thrombotic complications. We report the successful use of a specific chromogenic antifactor IIa assay in a patient with heparin-induced thrombocytopenia who received anticoagulation therapy with bivalirudin during cardiopulmonary bypass for coronary artery bypass graft surgery.

One hundred and sixty six patients were questioned by means of a multiple choice questionnaire, to determine their knowledge of peri-operative care, anaesthesia and the r61e of anaesthetists. In general, knowledge was good, but there were some important misconceptions; in particular, 28.3% of respondents thought that fasting referred to food only, and not to fluid intake. In addition, 47.6% of respondents considered pain to be a necessary part of the healing process and 38.6% believed that it was something that just had to be endured. When .forthcorning anaesthesia is discussed, anaesthetists need to ascertain that patients really do understand the language used.

Methods. All patients aged 80 years or older (n ‫؍‬ 282) undergoing isolated AVR between November 1995 and June 2006 at our institution were reviewed according to logistic EuroSCORE (ES log ) risk stratification. Surgical risk was defined as low risk (ES log < 10% [n ‫؍‬ 107]), moderate risk (10% < ES log < 20% [n ‫؍‬ 103]), and high risk (ES log > 20% [n ‫؍‬ 72]). Patient age was 82 ؎ 2 years (low risk), 82.7 ؎ 2.7 years (moderate risk), and 83.6 ؎ 3.1 years (high risk), respectively (p < 0.05). Mean ES log predicted risk of mortality was 7.3% ؎ 1.4% (low risk), 13.7% ؎ 2.5% (moderate risk), and 33.0% ؎ 11.5% (high risk; p < 0.05). Follow-up was 99.7% complete.

A reproducible large animal model of fulminant hepatic failure was developed in the anesthetized dog by the administration of the amino sugar D-galactosamine. Galactosamine in 5% dextrose in water (DsW), was given as an intravenous bolus to 10 young male dogs weighing 27 to 30 kg. Three dogs that received an equal volume of D5W alone served as controls. Galactosamine at 0.5 g/ kg (n = 5) produced significant biochemical evidence of liver injury with 100% survival at 48 hours. Galactosamine 1.0 g/kg (n = 5) yielded in 100% 48-hour mortality resulting from fulminant liver failure characterized by a progressive increase in liver enzymes, total bilirubin, ammonia, and lactate and associated coagulopathy, hypoglycemia, coma, and increased intracranial pressure. Necropsy showed liver pallor, ascites, and brain swelling. Liver histology showed significant hepatocellular necrosis. This clinically relevant large animal model will enable the quantitative evaluation of new technologies, such as the bioartificial liver, for the support of hepatic failure in humans. 21:796-804.) Abbreviations: FHF, fulminant hepatic failure; IV, intravenous. From the Departments of 1Surgery, 2Medicine, and 4Chemical Engineering and Materials Sciences, University of Minnesota, Minneapolis; and 3Cellex Biosciences, Coon Rapids, MN.

Appendicitis is an inflammation of the appendix vermiformis. Management of
appendicitis is with surgery (appendiktomi) that may cause postoperative pain. Analgesic tramadol is one kind of opioid analgesics, whereas ketorolac is one type of non-opioid analgesics. The study is an observational analytic study using secondary data. The subject of
the study amounted to 38 people who have done appendiktomi laparoscopic group, consisted of 20 people with tramado l(tramadol group) and 18 people with ketorolac (ketorolac group). All
study subjects were then calculated how long the duration of post-operation pain free. The results of this study showed that the average duration of pain-free for the tramadol group is 6.42
hours (6 hours 25 minutes), while for the ketorolac group is 5.91 hours (5 hours 54 minutes). Based on independent sample t-test analysis test, there were no significant differences in the
average duration of pain-free patients in both groups (p> 0.05), so it can be concluded that tramadol and ketorolac have the same level of effectiveness in the management of pain in post appendiktomi in PKU Muhammadiyah Hospital of Yogyakarta.
Keywords: analgesic, tramadol, ketorolac, appendectomy, effectiveness.

Case Report:A 38 years old patient was scheduled for fetal MMC in utero repair. The fetus presented a lumbosacral MMC and Arnold Chiari type II malformation. Magnesium sulfate was administered for fetal neuroprotection. We provided a latex free environment (LFE). Uterine relaxation (UR) was achieved by indomethacin, atosiban, nitroglycerin and sevoflurane. Rapid sequence intubation was performed using fentanyl, propofol and rocuronium. Anesthesia maintenance was achieved by target controlled infusion (TCI) of remifentanil, sevoflurane and fentanyl. Bispectral Index (BIS) was used to monitor depth of anesthesia. As there is a known risk of pulmonary edema 1 , we decided to maintain a goal directed fluid management, using EV1000® to estimate systolic volume variation and cardiac output. Norepinephrine was used to maintain maternal blood pressure. Fentanyl, atropine and vecuronium were administered intramuscularly to the fetus. Fetal heart rate was registered by echocardiography. Surgery was completed without any maternal or fetal complications.

Background. Evidence from multiple trials demonstrates the efficacy of prophylactic ␤-blocker, amiodarone, and corticosteroid administration in reducing the incidence of postoperative atrial fibrillation. Despite this information, these interventions remain infrequently or inappropriately utilized. This study was designed to assess the frequency with which these prophylactic strategies are currently being used and to identify concerns and barriers to more widespread application. Methods. A link to an online survey was e-mailed to all practicing cardiac surgeons in Canada. Each surgeon was given a unique log-in identification number to complete the survey online through a secure web page. Results. Surveys were sent to 166 surgeons; 119 completed surveys (72%) were returned. Only 58% of respondents routinely use ␤-blockade for prophylaxis. For nonusers, 44% are unconvinced of the evidence for this practice. The routine use of amiodarone among surgeons was 19%. Of the remainder, 43% cited a perceived increased risk of complications as the reason for not using this therapy. An additional 29% considered the therapy was excessively complicated or time consuming. Corticosteroids were routinely used by only one surgeon. Major barriers to use of steroids were unconvincing evidence (76%), a perceived increased risk of wound infection (38%), and hyperglycemia (30%). Conclusions. Despite level 1 evidence, the use of ␤-blockers, amiodarone, and corticosteroids for prophylaxis of atrial fibrillation among Canadian surgeons remains less than expected. The results of this survey support the need for further clinical trials with robust and clinically relevant outcomes that may further influence surgeons to adopt this practice.

This study evaluates the effects of a spearmint (/-carvone) and wintergreen oil (methyl salicylate) emulsion (CMSE) on age 1 landlocked Atlantic salmon Salmo salar sebago (hereafter salmon). Salmon were immersed in either 257 µl/L CMSE or 75 mg/L tricaine methanesulfonate (MS-222) to induce anesthesia (stage 4), useful for emersion and noninvasive husbandry procedures, and then salmon were recovered in fresh water. Induction was quicker in the CMSE group; however, recovery was quicker in the MS-222 group. A second experiment was conducted in which salmon were immersed in 257 µl/L CMSE for 8.5 min, or 75 mg/L MS-222 for 8.5 min in order to compare electrocardiographs during deeper anesthesia (stage 5) between salmon continuously immersed in CMSE to those continuously immersed in MS-222. Because salmon remained sedated longer after CMSE exposure than after MS-222 exposure, a third group of salmon was immersed in 257 µl/L CMSE for just 2.5 min before undergoing the 6-min electrocardiog...

Anesthetic care depends on the patient underlying condition. Local anesthesia is preferable. Do not use heavy sedation. If you use GA avoid suxamethonium. If the PM was recently implanted, avoid N2O. During operation change to fixed-rate. Precautions for electrocautery. Post-operatively inform cardiologist to readjust the PM.

We have carried out a laboratory evaluation of an active heat and moisture exchanging filter (aHMEF). The device consists of a conventional heat and moisture exchanging filter (HMEF) with an additional heating element and water supply. It was compared with a standard HMEF using a model lung. The aHMEF with the heating element alone, reduced 2-hourly water loss compared with the HMEF (? < 0.001); with both the heating element and additional water, this was reduced further (P < 0.001). The mean catheter mount temperature with the HMEF and heater was 32.7 (SD 1.8) °C and with the complete aHMEF was 34.6 (1.6) °C. The maximum temperature with the heating element in use was 37.7 °C. We conclude that the aHMEF provided effective, controllable and convenient humidification of inspired gases. (Br.

Carbon dioxide (CO,) insufflation with increased intraabdominal pressure (IAP) has adverse hemodynamic, pulmonary, and renal effects. To avoid these problems, an abdominal wall lift method with a retractor was used to provide the surgical view without CO2 insufflation. Twenty-six patients undergoing elective laparoscopic cholecystectomy were randomly allocated to either the gasless, retractor group, or conventional CO, pneurnoperitoneum group (CPP). Hemodynamic data, ventilatory variables, urine output, urine oxygen tension, and blood samples for determining stress hormones were collected throughout the perioperative period. Patients in the retractor group had lower mean arterial pressure, heart rate, and central venous pressure (P < 0.001). They also had higher pulmonary dynamic compliance and needed a lower minute volume of ventilation to achieve normocarbia (P < 0.001). Urine output and oxygen tension in urine were higher (P < 0.05) with the retractor method than with CPP. Increase in plasma renin activity (P < 0.05) and decrease in core temperature (P < 0.001) were smaller with the gasless method than with CPP. The gasless method for laparoscopic cholecystectomy might be beneficial, especially in patients with compromised cardiorespiratory or renal function. Implications:

Intense production pressure has focused on the preincision period (from patienton-table to incision) as an important component of overall operating room efficiency. We conducted a prospective study in which trained independent observers measured the performance of anesthesiologists, surgeons, and nursing staff to determine anesthesia release time (ART, patient-on-table until release for surgical preparation) and surgical preparation time (SPT, start surgical preparation to incision) and the factors, including delays, that affect their duration. We enrolled 1558 patients undergoing elective surgery in a tertiary medical center. The mean ART was 21 Ϯ 16 min. Mean SPT was 22 Ϯ 13 min, and mean case length was 207 Ϯ 123 min. Significant variation was seen in both ART (range, 1-115 min) and SPT (range, 1-130 min). Multivariate regression analysis revealed ASA physical status, age, level of resident training, invasive monitoring, case length, and case number in the room were all positive predictors of ART duration (P Ͻ 0.05). In contrast, gender, body mass index, number of anesthesia personnel concurrently in the room, and number of rooms covered per anesthesia attending were not predictors for ART (P Ͼ 0.05). Delays affected both ART and SPT and were encountered in 24.5% of all procedures (surgery 66.8%, anesthesiology 21.7%, and logistical 11.5%). For operating room scheduling purposes, we conclude that assigning a constant fixed duration for anesthetic induction is inappropriate and will result in creating erroneous administrative expectations.

Background. Our understanding of traumatic diaphragmatic injury (TDI) is based primarily on outdated retrospective series. We sought to reexamine present day patterns of diagnosis, associated injuries, predictors of mortality, and long-term outcomes of this condition.

We describe one of the few pediatric cases of central anticholinergic syndrome (CAS) in an 8-year-old boy undergoing elective surgery. Deep sedation, inadequate response to stimuli and reduced muscular tone of the upper airway resulting in airway obstruction were the clinical manifestations of CAS. The symptoms resolved immediately after administration of physostigmine. This case illustrates the importance of considering central anticholinergic syndrome as a differential diagnosis in children if prolonged sedation after general anesthesia occurs.

Force on Colorectal Cancer sets a target of cecal intubation in at least 90% of colonoscopies. We conducted a population-based study to determine the colonoscopy completion rate and to identify factors associated with incomplete procedures. Methods: Men and women 50 to 74 years of age who underwent a colonoscopy in Ontario between January 1, 1999, and December 31, 2003, were identified. The first (index) colonoscopy was classified as complete or incomplete. A generalized estimating equations model was used to evaluate the association between patient, endoscopist (specialty, colonoscopy volume), and setting (academic hospital, community hospital, private office) factors and incomplete colonoscopy. Results: A total of 331,608 individuals had an index colonoscopy, of which 43,483 (13.1%) were incomplete. Patients with an incomplete colonoscopy were older (odds ratio [OR] 1.20 per 10-year increment; 95% confidence interval [CI] ‫؍‬ 1.18 -1.22), more likely to be female (OR 1.35; 95% CI: 1.30 -1.39), have a history of prior abdominal surgery (OR 1.07; 95% CI: 1.05-1.09) or prior pelvic surgery (OR 1.04; 95% CI: 1.01-1.06). For colonoscopies done in a private office, the odds of an incomplete procedure were more than 3-fold greater than for procedures done in an academic hospital (OR 3.57; 95% CI: 2.55-4.98). Conclusions: In usual clinical practice in Ontario, 13.1% of colonoscopies are incomplete. The factors most strongly associated with incomplete colonoscopy were increased patient age, female sex, and having the procedure in a private office. Quality improvement programs are needed to improve colonoscopy completion rates.

Background-Low tidal volume ventilation for Acute Respiratory Distress Syndrome (ARDS) is a well accepted concept. However, controversy persists regarding the optimal ventilator settings for ventilated patients without ARDS. This study tested the hypothesis that ventilator settings influence the development of new ARDS. Methods-Retrospective analysis of patients from the MIMIC-II database who were mechanically ventilated for ≥48 hours between 2001 and 2005. Results-2583 patients required greater than 48 hrs of ventilation. Of 789 patients who did not have ARDS at admission, 152 (19%) went on to develop ARDS. Univariate analysis revealed high peak inspiratory pressure (PIP) (OR 1.53 per standard deviation, 95% confidence interval 1.28-1.84), increasing PEEP (OR 1.35 per SD, 95%CI 1.15-1.58) and tidal volume (OR 1.36 per SD, 95%CI 1.12-1.64) to be significant risk factors. Major non-ventilator risk factors for ARDS included sepsis, low pH, elevated lactate, low albumin, transfusion of packed red blood cells, transfusion of plasma, high net fluid balance, and low respiratory compliance. Multivariable logistic regression showed that peak pressure (OR 1.31 per SD, 95%CI 1.08-1.59), high net fluid balance (OR 1.3 per SD, 95%CI 1.09-1.56), transfusion of plasma (OR 1.26 per SD, 95%CI 1.07-1.49), sepsis (OR 1.57, 95%CI 1.00-2.45) and tidal volume (OR 1.29 per SD, 95%CI 1.02-1.52) were significantly associated with the development of ARDS. Conclusions-The associations between the development of ARDS and clinical interventions, including high airway pressures, high tidal volume, positive fluid balance and transfusion of blood products, suggests that ARDS may be a preventable complication in some cases.

Background: No objective measure of the level of sedation is universally accepted. However, bispectral index monitoring is currently used to objectively measure sedation levels in several clinical settings. This study compares the temporal relationship of bispectral index levels versus the Observer's Assessment of Alertness/Sedation (OAA/S) scale for sedation during endoscopy and proposes a functional bispectral index range for endoscopic procedures. Methods: Fifty consecutive adults undergoing endoscopic retrograde cholangiopancreatography, colonoscopy, or esophagogastroduodenoscopy by a single endoscopist were studied. Intravenous sedation was achieved with diazepam and meperidine. Bispectral index levels (0 to 100) and OAA/S scores (1 to 5) were recorded every 3 minutes by a single trained observer. Results: There were significant temporal correlations between bispectral index levels and OAA/S scores (r = 0.59, p < 0.0001). Bispectral index levels and OAA/S scores corresponded with the need for additional sedation as determined clinically by the endoscopist. An OAA/S score of 3 corresponded to a bispectral index level of 81.49 ± 9.78. Conclusions: Bispectral index monitoring temporally correlates with the OAA/S scale and therefore provides an objective measure of sedation during endoscopy. This preliminary, observational study suggests that a bispectral index level near 82 corresponds with sufficient and functional sedation levels for endoscopy. (Gastrointest Endosc 2000;52:192-6.)

The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications. From March, 2010 to March, 2012, 53 LVADs (50 Heart Mate II and 3 Heart Ware) were implanted in patients in our department. UFTA was successfully performed (LVAD ultra ) in 13 patients. After propensity score matching, we compared the LVAD ultra group with a matched group (LVAD match ) receiving conventional anesthesia management. Patients in the LVAD ultra group had significantly lower incidences of pneumonia (p = 0.031), delirium (p = 0.031) and...

Background Anesthesia departments and intensive care units represent two advanced, high-tech, and complex care environments. Health care in those environments involves different types of technology to provide safe, high-quality care. Smart glasses have previously been used in different health care settings and have been suggested to assist health care professionals in numerous areas. However, smart glasses in the complex contexts of anesthesia care and intensive care are new and innovative. An overview of existing research related to these contexts is needed before implementing smart glasses into complex care environments. Objective The aim of this study was to highlight potential benefits and limitations with health care professionals&#39; use of smart glasses in situations occurring in complex care environments. Methods A scoping review with six steps was conducted to fulfill the objective. Database searches were conducted in PubMed and Scopus; original articles about health care ...

ACC ϭ American College of Cardiology AHA ϭ American Heart Association CT ϭ computed tomography CTA ϭ computed tomography angiography IE ϭ infectious endocarditis MA ϭ mycotic aneurysm MRA ϭ magnetic resonance angiography MRI ϭ magnetic resonance imaging MVR ϭ mitral valve replacement PVE ϭ prosthetic valve endocarditis 2013 Ann Thorac Surg REPORT FROM STS WORKFORCE ON EVIDENCE BASED SURGERY BYRNE ET AL 2011;91:2012-9

Background: Although multiple combinations of weather factors may contribute to an increased incidence of Mycoplasma pneumoniae pneumonia, few studies have investigated the association between weather factors and cases of M pneumoniae pneumonia. Methods: Data on cases of M pneumoniae pneumonia and weather factors in Fukuoka, Japan from 1999 to 2007 were obtained and time-series analysis was used to assess the effects of weather variables on M pneumoniae pneumonia cases, adjusting for confounding factors. A total of 13 056 M pneumoniae pneumonia cases were reported during the 9-year study period, of which 12 234 (93.7%) were under 15 years of age. Results: The weekly number of M pneumoniae pneumonia cases increased by 16.9% (95% CI 11.3% to 22.8%) for every 1uC increase in the average temperature and by 4.1% (95% CI 2.7% to 5.5%) for every 1% increase in relative humidity. Conclusions: From 1999 to 2007, cases of M pneumoniae pneumonia increased significantly with increased average temperature and relative humidity in Fukuoka, Japan.

Propofol causes pain on IV injection in 28%-90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg and lidocaine 40 mg after venous occlusion for prevention of propofol-induced pain. One-hundred-twenty-four adult patients, ASA physical status I-II, undergoing elective surgery were randomly assigned into 4 groups of 31 each. Group I received normal saline, group II received lidocaine 2% (40 mg), and groups III and IV received thiopental 0.25 mg/kg and 0.5 mg/kg, respectively. All pretreatment drugs were made in 2 mL and were accompanied by manual venous occlusion for 1 min. Propofol was administered after release of venous occlusion. Pain was assessed with a four-point scale: 0 ϭ no pain, 1 ϭ mild pain, 2 ϭ moderate pain, and 3 ϭ severe pain at the time of propofol injection. Twenty-four patients (77%) complained of pain in the group pretreated with normal saline as compared with 12 (39%), 10 (32%), and 1 (3%) in the groups pretreated with lidocaine 40 mg, thiopental 0.25 mg/kg, and thiopental 0.5 mg/kg, respectively (P Ͻ 0.05). Thiopental 0.5 mg/kg was the most effective treatment. We therefore suggest routine pretreatment with thiopental 0.5 mg/kg along with venous occlusion for 1 min for prevention of pain associated with propofol injection.

We report a case supporting the use of telecommunications technology from a remote location to monitor anesthetic events. Vital signs, data, and video were transmitted from surgery conducted in the remote Amazonian rainforests of Ecuador to Richmond, VA.

Satisfactory analgesia cannot be achieved in every obturator nerve block. To attempt to improve the success rate of obturator nerve block, this study describes the detailed anatomy of the obturator region and canal. Eleven (5 female and 6 male) cadavers, totally 22 sides were dissected. Anatomical positions of the structures entering and leaving the canal were defined. The position of the obturator nerve and its branches and their relation with the obturator artery, vein, and with the internal iliac and femoral veins were investigated. A mould of the canal and a model were created. Detailed measurements were performed on the cadavers and models. The obturator canal was in the shape of a funnel compressed from superior to inferior, with anterior and posterior openings. At the entrance of the canal, the nerve lay superiorly; the artery was in the middle, and the vein lay inferiorly. The obturator nerve ran close to the lateral wall of the obturator canal. The distance of lateral wall of obturator canal to the median plane was 41.4 ± 1.1 mm. After leaving the canal, the nerve lay laterally while the anterior branch of the artery was medial. A venous plexus lay between the two structures. The presence of the branches of the obturator artery and vein alongside the obturator nerve may increase the risk of injury to these structures during anaesthetic procedures. The anterior division of the obturator nerve has a close relationship with these vessels. To provide complete analgesia, the obturator nerve should be blocked in the obturator canal or at its external orifice.

Methods. Between January 1, 2000, and December 31, 2007, 1413 patients underwent elective AVR at Mayo Clinic. Two propensity-matched groups at low risk for acute kidney injury were created: 321 patients with coronary angiography on the same day as AVR (same day) and 321 patients with coronary angiography more than 1 day before AVR (non-same day). We defined acute postoperative kidney injury with Acute Kidney Injury Network criteria (> 0.3 mg/dL or a 50% increase in serum creatinine from baseline).