Survey of Anesthesiology最新文献

{"title":"Grading Aortic Stenosis With Mean Gradient and Aortic Valve Area: A Comparison Between Preoperative Transthoracic and Precardiopulmonary Bypass Transesophageal Echocardiography.","authors":"George B. Whitener, J. Sivak, I. Akushevich, Zainab Samad, M. Swaminathan","doi":"10.1097/01.sa.0000513503.04221.40","DOIUrl":"https://doi.org/10.1097/01.sa.0000513503.04221.40","url":null,"abstract":"OBJECTIVE\u0000The authors hypothesized that average precardiopulmonary bypass (pre-CPB) transesophageal echocardiographic (TEE) mean gradient (PGm) and aortic valve area (AVA) values would be significantly different from preoperative transthoracic (TTE) values in the same patients and that these changes would affect pre-CPB TEE grading of aortic stenosis (AS).\u0000\u0000\u0000DESIGN\u0000Retrospective, observational design.\u0000\u0000\u0000SETTING\u0000Single university hospital.\u0000\u0000\u0000PARTICIPANTS\u0000The study comprised 92 patients who underwent aortic valve replacement with or without coronary artery bypass grafting between 2000 and 2012 at Duke University Hospital and who had PGm and AVA values recorded in both pre-CPB TEE and preoperative TTE reporting databases.\u0000\u0000\u0000INTERVENTIONS\u0000None.\u0000\u0000\u0000MEASUREMENTS AND MAIN RESULTS\u0000PGm with pre-CPB TEE was lower by 6.6 mmHg (95% confidence interval, -4.0 to -9.3 mmHg; p<0.001), whereas AVA was higher by 0.10 cm(2) (95% confidence interval, 0.04 to 0.15 cm(2); p<0.001), compared with preoperative TTE values. When using PGm, pre-CPB TEE generated an AS severity 1 grade lower 39.1% of the time and revealed no difference 55.4% of the time compared to preoperative TTE. When using AVA by continuity, pre-CPB TEE generated an AS severity 1 grade lower 14.1% of the time and revealed no difference 81.5% of the time compared to preoperative TTE. When using either PGm or AVA, preoperative TTE exhibited moderate or severe AS for all study patients, whereas, pre-CPB TEE demonstrated mild AS in 5.4% (n = 92) of patients.\u0000\u0000\u0000CONCLUSIONS\u0000The authors confirmed their hypothesis that pre-CPB TEE generates different PGm and AVA values compared with preoperative TTE. These differences often underestimate AS severity. Hemodynamic standardizations or adjustments of pre-CPB TEE PGm and AVA values may be necessary in anesthetized patients before assigning an AS grade using these parameters.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80581743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest","authors":"L. Andersen, K. Berg, Brian Z. Saindon, J. Massaro, T. Raymond, R. Berg, V. Nadkarni, M. Donnino","doi":"10.1097/01.sa.0000490924.18788.5c","DOIUrl":"https://doi.org/10.1097/01.sa.0000490924.18788.5c","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89322915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexamethasone Alone Versus in Combination With Transcutaneous Electrical Acupoint Stimulation or Tropisetron for Prevention of Postoperative Nausea and Vomiting in Gynaecological Patients Undergoing Laparoscopic Surgery","authors":"X. Y. Yang, J. Xiao, Y. H. Chen, Z. Wang, H. Wang, D. He, J. Zhang","doi":"10.1097/01.SA.0000490915.28178.BA","DOIUrl":"https://doi.org/10.1097/01.SA.0000490915.28178.BA","url":null,"abstract":"wherein nausea and vomiting were the secondary end points, triggering criticism about insufficient power and increased heterogeneity. The current study was tailored to address these limitations by assessing the pooled effects of preoperative gabapentin among studies designed to explore PONV as a primary end point. This approach showed that preoperative gabapentin reduced postoperative nausea, vomiting, and rescue antiemetic requirements. Additional analysis of all included trials that cited PONV end points (primary or secondary) also resulted in the conclusion that preoperative gabapentin was associated with a reduced incidence of PONV, nausea, vomiting, and rescue antiemetic requirement. These findings, as a result of pooled data from the largest cohort of trials to date, suggest a role for preoperative gabapentin in the prevention of PONV. The mechanism by which gabapentin attenuates PONV is debatable. Some studies have postulated a reduction in calcium signaling in the area postrema, as well as reduced tachykinin neurotransmission. Others have suggested a decrease in postoperative inflammation, thereby mitigating ileus and subsequent PONV. Still, others point to the reduction in perioperative opioid requirements associated with gabapentin as the operative mechanism. One might conjecture that some combination of these mechanisms may be responsible. Nonetheless, the central nervous system effects of gabapentin must be acknowledged. Potential excessive sedation and dizziness in the postoperative period have been reported, although the current study did not identify an association between gabapentin and dizziness/lightheadedness, headache, and drug mouth. The current investigation, however, did detect notable incidences of excessive postoperative sedation and somnolence. Another unanswered question is whether preoperative gabapentin has any effect on postdischarge PONV. Certainly, the current meta-analysis should stimulate further research in many germane areas.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74641707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of a perceptual and adaptive learning module on transoesophageal echocardiography interpretation by anaesthesiology residents.","authors":"B. Romito, S. Krasne, P. Kellman, A. Dhillon","doi":"10.1097/SA.0000000000000282","DOIUrl":"https://doi.org/10.1097/SA.0000000000000282","url":null,"abstract":"BACKGROUND\u0000The role of transoesophageal echocardiography (TOE) in anaesthetic practice is expanding. We evaluated the effect of a TOE perceptual and adaptive learning module (PALM) on first-yr anaesthesiology residents' performance, in diagnosing cardiac pathology by TOE.\u0000\u0000\u0000METHODS\u0000First-yr residents were assigned to a group (n = 12) that used a TOE PALM or a control group that did not (n = 12). Both groups received a TOE pretest that measured their accuracy and response times. The PALM group completed the PALM and a posttest within 30 min and a delayed test six months later. The control group received a delayed test six months after their pretest. Accuracy and fluency (accurate responses within 10 s) were measured.\u0000\u0000\u0000RESULTS\u0000The PALM group had statistically significant improvements for both accuracy and fluency (P < 0.0001) in diagnosing cardiac pathology by TOE. After six months, the PALM group's performance remained significantly higher than their pretest values for accuracy (P = 0.0002, d = 2.7) and fluency (P < 0.0001, d = 2.3).\u0000\u0000\u0000CONCLUSIONS\u0000In this pilot study, exposure to a PALM significantly improved accuracy and fluency in diagnosing TOE cardiac pathology, in a group of first-year anaesthesiology residents. PALMs can significantly improve learning and pattern recognition in medical education.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72804696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study showing the extent of compliance with perioperative guidelines in patients with coronary stents with regard to double antiplatelet therapy.","authors":"Austin A. Woolard, Jesse M. Ehrenfeld, S. Eagle, J. Wanderer","doi":"10.1097/SA.0000000000000283","DOIUrl":"https://doi.org/10.1097/SA.0000000000000283","url":null,"abstract":"STUDY OBJECTIVE\u0000To evaluate perioperative dual antiplatelet therapy management in patients with previously placed coronary stents.\u0000\u0000\u0000DESIGN\u0000Retrospective medical record review.\u0000\u0000\u0000SETTING\u0000Academic medical center.\u0000\u0000\u0000PATIENTS\u0000A total of 1891 surgical cases performed at Vanderbilt University Medical Center in 2012 were evaluated using a perioperative database. Of these, 161 had complete data records that were evaluated using 2 evidence-based and expert opinion-supported protocols.\u0000\u0000\u0000INTERVENTIONS\u0000N/A.\u0000\u0000\u0000MEASUREMENTS\u0000This study is meant to evaluate perioperative antiplatelet management decisions in patients with coronary stents.\u0000\u0000\u0000MAIN RESULTS\u0000Management decisions were consistent with guidelines regarding antiplatelet therapy in 13% (21/161) of patients. Of the 87% (140/161) of cases where decisions were not consistent, 88% (123/140) were due to discontinuing aspirin preoperatively when there was not a high risk of surgical bleeding.\u0000\u0000\u0000CONCLUSIONS\u0000This study revealed suboptimal adherence to current perioperative antiplatelet management guidelines in patients with coronary stents. The lack of adherence to current guidelines is concerning and could be used to support the notion of an anesthesiologist-led Perioperative Surgical Home.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87088700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxygen Therapy: When Is Too Much Too Much?","authors":"S. Shaefi, D. Talmor, B. Subramaniam","doi":"10.1097/SA.0000000000000292","DOIUrl":"https://doi.org/10.1097/SA.0000000000000292","url":null,"abstract":"H istorically, extreme care has been taken to avoid periods of hypoxemia with low blood oxygen levels in patients during anesthesia. This is particularly the case during surgery involving cardiopulmonary bypass (CPB), as hypoxemia is known to be potentially harmful. However, because hyperoxemia (excess oxygen in the blood) was believed to be relatively harmless, little effort went into avoiding this condition. Recent clinical data seem to suggest otherwise. The potentially dangerous effects of hyperoxemia include the extension of infarct size status post myocardial infarction, adverse neurologic outcomes, and higher mortality rates in patients receiving therapeutic hypothermia following return of spontaneous circulation after cardiac arrest. As data regarding the detrimental effects of hyperoxemia have appeared, there has been a renewed interest in the potential role it may play in ischemia-reperfusion injury, reactive oxygen species production, and inflammation. In this issue ofAnesthesiology, McGuinness et al, in their article “A Multicenter, Randomized, Controlled Phase IIB Trial of Avoidance of Hyperoxemia During Cardiopulmonary Bypass,” investigate the avoidance of hyperoxemia during CPB and the possibility of reducing postoperative acute kidney injury. They","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90618324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Good News: But Why Is the Incidence of Postoperative Ischemic Optic Neuropathy Falling?","authors":"M. Todd","doi":"10.1097/01.sa.0000515841.55947.a5","DOIUrl":"https://doi.org/10.1097/01.sa.0000515841.55947.a5","url":null,"abstract":"The number of patients undergoing spinal fusion surgery in the United States is the highest in the world. Developing perioperative visual loss as a result of ischemic optic neuropathy (ION) is a rare complication. Patients undergoing either cardiac or spinal fusion surgery are at risk of developing ION; hence, it becomes relevant to uncover the risk factors and preventive measures for such rare but serious complications. The purpose of this study was to determine trends in ION occurrence in spinal fusion and risks in a nationwide administrative hospital database. Between 1998 and 2012, procedure codes for posterior thoracic, lumbar, or sacral spine fusion and diagnostic codes for ION were identified in the Nationwide Inpatient Sample. Ischemic optic neuropathy was studied over 3-year periods between 1998 and 2000, 2001 and 2003, 2004 and 2006, 2007 and 2009, and 2010 and 2012. Trend weights in a statistical survey procedure were used to arrive at national estimates. The assessed trends and risk factor data were analyzed using univariate and Poisson logistic regression. It was estimated that between 1998 and 2012 there were 2,511,073 thoracic, lumbar, and sacral spinal fusion surgeries nationally. Ischemic optic neuropathy was estimated to develop in 257 patients (1.02/10,000). The incidence rate ratio (IRR) for ION significantly decreased between 1998 and 2012 (IRR, 0.72 per 3 years; 95% confidence interval [CI], 0.58–0.88; P = 0.002). There was no significant change in the incidence of retinal artery occlusion. Factors significantly associated with ION were age (IRR, 1.24 per 10 years of age; 95% CI, 1.05–1.45; P = 0.009), transfusion (IRR, 2.72; 95% CI, 1.38–5.37; P = 0.004), and obesity (IRR, 2.49; 95% CI, 1.09–5.66; P = 0.030). Female sex was protective (IRR, 0.30; 95% CI, 0.16–0.56; P = 0.0002). It was found that the risk of ION increased significantly with age, male sex, transfusion, and obesity. This study demonstrated a significant decrease in ION following spinal fusion. The incidence has been reduced by a third (2.7-fold) between 2010–2012 and 1998–2000. There was not any change in the occurrence of retinal artery occlusion in the same periods, implying that the processes resulting in these 2 complications are not the same. Clear conclusions could not be drawn by the authors about the reasons behind the decrease in ION. It is possible they are a result of perioperative surgical and/ or anesthetic practice changes following national practice advisories and recommendations. Further studies are recommended.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82241394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure: A Randomized Clinical Trial","authors":"M. Curley, D. Wypij, R. Watson, M. Grant, L. Asaro, I. Cheifetz, B. Dodson, L. Franck, R. Gedeit, D. Angus, M. Matthay","doi":"10.1097/01.sa.0000484846.95958.c5","DOIUrl":"https://doi.org/10.1097/01.sa.0000484846.95958.c5","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86902371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Tracheostomy Timing on Clinical Outcome and Adverse Events in Poor-Grade Subarachnoid Hemorrhage","authors":"F. Gessler, H. Mutlak, S. Lamb, M. Hartwich, M. Adelmann, J. Platz, J. Konczalla, V. Seifert, C. Senft","doi":"10.1097/01.sa.0000484861.93236.90","DOIUrl":"https://doi.org/10.1097/01.sa.0000484861.93236.90","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77917988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Opioids and Public Health","authors":"E. Kharasch, L. Brunt","doi":"10.1097/01.SA.0000484833.78972.48","DOIUrl":"https://doi.org/10.1097/01.SA.0000484833.78972.48","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77301360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}