The American journal of anesthesiology最新文献

Friendliness of OR staff is top determinant of patient satisfaction with outpatient surgery. 手术室工作人员的友好程度是门诊手术患者满意度的首要决定因素。

The American journal of anesthesiology Pub Date : 1998-07-01

E M Tarazi, B K Philip

引用次数: 0

Swallowing topically administered 4% lidocaine results in nausea and vomiting. 局部吞咽4%利多卡因导致恶心和呕吐。

The American journal of anesthesiology Pub Date : 1998-07-01

J L Benumof, D Feroe

{"title":"Swallowing topically administered 4% lidocaine results in nausea and vomiting.","authors":"J L Benumof, D Feroe","doi":"","DOIUrl":"","url":null,"abstract":"In preparing adult volunteers for insertion of an upper airway device, we observed a high incidence of nausea and vomiting in the first 16 consecutive volunteers who were allowed to swallow topically administered 4% lidocaine (50% and 31%, respectively). We tested the hypothesis that swallowing the topically administered 4% lidocaine caused the nausea and vomiting by comparing the incidence of nausea and vomiting in these first 16 volunteers with the incidence of nausea and vomiting in the next 162 consecutive awake adult volunteers who were not allowed to swallow the 4% lidocaine. All 178 volunteers were prepared by administering 2 mg midazolam and 100 micrograms fentanyl intravenously, spraying 10 to 15 mL of 4% lidocaine into the upper airway, and bilaterally blocking the lingual branch of nerve IX and the superior laryngeal branch of nerve X. The first 16 volunteers were allowed to swallow the 4% lidocaine (swallow/no suction, group A); the next 162 volunteers were not allowed to swallow the 4% lidocaine, and all of the 4% lidocaine was suctioned out of the upper airway (no swallow/suction, group B). Groups A and B were otherwise and subsequently treated identically. The incidence of nausea and vomiting in group A was 50% (8/16) and 31% (5/16), respectively, and in group B, 4% (7/162) and 1% (2/162), respectively. The difference in the incidence of nausea and vomiting between group A and group B was highly significant by chi-square analysis (P < 0.01). We found that swallowing topically administered 4% lidocaine results in a significant increase in the incidence of nausea and vomiting. Our experimental design did not allow us to rule out either of two basic mechanisms, higher blood levels and a direct toxic effect, or to distinguish between them. The clinical implication of this study is that suctioning all topically administered 4% lidocaine will decrease the incidence of nausea and vomiting.","PeriodicalId":80191,"journal":{"name":"The American journal of anesthesiology","volume":"25 4","pages":"150-2"},"PeriodicalIF":0.0,"publicationDate":"1998-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21057952","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}

引用次数: 0

Iontophoresis: noninvasive drug delivery. 离子导入:无创给药。

The American journal of anesthesiology Pub Date : 1998-07-01

W T Zempsky, M A Ashburn

引用次数: 0

A computer model comparing normovolemic hemodilution, hypervolemic hemodilution, and neither on intraoperative blood loss and final hematocrit. 一个比较等容血稀释、高容血稀释和术中出血量和最终红细胞压积的计算机模型。

The American journal of anesthesiology Pub Date : 1995-09-01

M Engoren

{"title":"A computer model comparing normovolemic hemodilution, hypervolemic hemodilution, and neither on intraoperative blood loss and final hematocrit.","authors":"M Engoren","doi":"","DOIUrl":"","url":null,"abstract":"Homologous blood transfusion, while frequently life-saving, is attended by risks and complications. Autologous blood transfusions have become an increasingly common alternative. Volume expansion, which is simpler, also is used. This study was designed to construct computer models of hypervolemic hemodilution and normovolemic hemodilution to compare them with each other and with normal (neither hypervolemic nor normovolemic hemodilution). Each model started with blood volume (BV) equal to 5,000 mL. Initial hematocrits (HCTs) were varied from 25% to 50%. Following phlebotomy and hemodilution or volume expansion, which ranged from 0 to 2,500 mL (50% of initial BV), the models were then bled 250 to 2,500 mL (5% to 50% of initial BV). In the phlebotomy model, the autologous blood was then returned. Final HCTs were then calculated. Preoperative phlebotomy of 500 to 1,000 mL, an amount commonly withdrawn, provides a minimally higher final HTC. Volume expansion by hypervolemic hemodilution provides almost the same low level of benefit. Benefits (3% higher HCT) are not seen until larger volumes are phlebotomized or hemodiluted and accompanied by large intraoperative blood losses. Autologous blood drawn by preoperative phlebotomy for intraoperative transfusion should not be used until studies show that these large volumes are safe and actually save blood.","PeriodicalId":80191,"journal":{"name":"The American journal of anesthesiology","volume":"22 5","pages":"229-34"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21031334","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}

引用次数: 0

Hemodynamic changes with initiation of veno-venous bypass in orthotopic liver transplant patients. 原位肝移植患者静脉-静脉分流术开始时血流动力学的变化。

The American journal of anesthesiology Pub Date : 1995-07-01

R D Kaufman, G F Khoury

{"title":"Hemodynamic changes with initiation of veno-venous bypass in orthotopic liver transplant patients.","authors":"R D Kaufman, G F Khoury","doi":"","DOIUrl":"","url":null,"abstract":"Removal of the liver to start the anhepatic stage of liver transplantation requires cross-clamping of the portal vein, inferior vena cava, and hepatic artery. Adverse effects occur from engorged splanchnic beds and decreased venous return. A veno-venous bypass from the inferior vena cava and portal vein to the axillary vein is used in an attempt to ameliorate these changes. The purpose of this study was to evaluate the effect of institution of veno-venous bypass on hemodynamics. Eight randomly selected adult patients undergoing orthotopic liver transplantation had general anesthesia induced with thiamylal and maintained with nitrous oxide and isoflurane. Cardiopulmonary data and arterial and mixed venous blood gases were measured prospectively using radial artery and pulmonary artery catheters. Measurements were taken under four conditions: (1) 10 minutes before bypass; (2) after partial bypass (vena cava to the axillary vein); (3) after partial bypass with portal vein clamping; and (4) after full bypass (vena cava and portal vein to the axillary vein). Statistically significant changes seen were a 22% decrease in cardiac output and a 47% increase in systemic vascular resistance (SVR). Bypass flow was lower than predicted. Venovenous bypass ameliorates, but does not fully prevent, the reduction of cardiac output and rise in SVR seen with initiation of the anhepatic stage. However, bypass does prevent the hypotension experienced during cross-clamping and for these reasons should be used routinely.","PeriodicalId":80191,"journal":{"name":"The American journal of anesthesiology","volume":"22 4","pages":"184-8"},"PeriodicalIF":0.0,"publicationDate":"1995-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21022624","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}

引用次数: 0

Analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum in children. Caudal block versus ilioinguinal/iliohypogastric block. 腹腔镜腹膜检查儿童腹股沟疝修补术后的镇痛效果。尾侧阻滞vs髂腹股沟/髂腹下阻滞。

The American journal of anesthesiology Pub Date : 1995-07-01

J D Tobias, G W Holcomb, J W Brock, W M Morgan, N O'Dell, S Lowe, G E Rasmussen

{"title":"Analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum in children. Caudal block versus ilioinguinal/iliohypogastric block.","authors":"J D Tobias, G W Holcomb, J W Brock, W M Morgan, N O'Dell, S Lowe, G E Rasmussen","doi":"","DOIUrl":"","url":null,"abstract":"The authors prospectively evaluated the efficacy of caudal epidural block versus local infiltration combined with ilioinguinal/iliohypogastric block for analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum. During standardized anesthetic care, 24 children were randomized to Group I (caudal epidural block with 1.2 mL/kg of 0.25% bupivacaine) or to Group II (local infiltration with an ilioinguinal/iliohypogastric block). Postoperative pain scores were significantly lower at all four evaluation points in Group I than in Group II. Patients in Group I had a significantly decreased requirement for supplemental intravenous fentanyl. Intra-operative requirements for isoflurane were decreased in Group I. The expired concentration of isoflurane was 0.4 +/- 0.1 (mean +/- SEM) in Group I and 1.5 +/- 0.3 in Group II. Time to extubation was 3.8 +/- 0.5 minutes in Group I and 8.2 +/- 1.1 minutes in Group II. The time from arrival in the postanesthesia care unit until discharge home was 113 +/- 3 minutes in Group I and 152 +/- 11 minutes in Group II. Caudal epidural block was more effective than local infiltration in controlling pain after herniorrhaphy with laparoscopy in children and resulted in earlier discharge home.","PeriodicalId":80191,"journal":{"name":"The American journal of anesthesiology","volume":"22 4","pages":"193-7"},"PeriodicalIF":0.0,"publicationDate":"1995-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21043297","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}

引用次数: 0

Guidelines for the role of the clinical director of anesthesiology. The Association of Anesthesia Clinical Directors. 麻醉学临床主任角色指南。麻醉临床主任协会。

The American journal of anesthesiology Pub Date : 1995-07-01

W J Mazzei

引用次数: 0

Older anesthetic agents: should they be removed from clinical use? 旧麻醉剂:是否应该停止临床使用?

The American journal of anesthesiology Pub Date : 1995-05-01

R S Twersky, I H Sampson

引用次数: 0

Leak rate of latex gloves after tearing adhesive tape. 胶布撕裂后乳胶手套泄漏率。

The American journal of anesthesiology Pub Date : 1995-05-01

R C Cork, D Wood, B Evans, K deLanzac, M Naraghi

{"title":"Leak rate of latex gloves after tearing adhesive tape.","authors":"R C Cork, D Wood, B Evans, K deLanzac, M Naraghi","doi":"","DOIUrl":"","url":null,"abstract":"Anesthesiologists use latex gloves to provide barrier protection against infectious disease or contamination while providing anesthetic services. The performance of these services often involves tearing tape. The purpose of this study was to test the effect of tearing adhesive tape on permeability of latex examination gloves and to test the effect of an adhesive-sparing moisturizing cream on permeability of latex gloves used to tear adhesive tape. In a blinded, randomized, controlled laboratory experiment, 48 nonsterile latex examination gloves (24 pairs) were randomized to 1 of 2 groups. Adhesive-sparing moisturizing cream, 0.1 mL, was applied to 12 glove pairs; the remaining 12 pairs served as controls. Each of the 24 pairs of gloves were used to tear five 4-cm strips of cloth adhesive tape from a standard 1 1/2-inch roll. After initial inspection for obvious tears, each glove was tested for leaks using the watertight test as specified by the American Society for Testing and Materials (ASTM). Data recorded included the identity of the investigator tearing tape, number of holes initially observed, number of holes observed from the ASTM test, location of holes, glove classification as right or left hand, and treatment group. Based on the study, the authors concluded that health care providers who tear adhesive tape while wearing latex gloves should be aware that there is a high probability that the gloves no longer form a protective barrier and that adhesive-sparing moisturizing cream applied before tape is torn increases barrier protection.","PeriodicalId":80191,"journal":{"name":"The American journal of anesthesiology","volume":"22 3","pages":"133-7"},"PeriodicalIF":0.0,"publicationDate":"1995-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21022237","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}

引用次数: 0

Accidental needlesticks: do anesthesiologists practice proper infection control precautions? 意外针刺:麻醉医师是否采取适当的感染控制措施?

The American journal of anesthesiology Pub Date : 1995-05-01

A D Rosenberg, D B Bernstein, R L Bernstein, M L Skovron, S Ramanathan, H Turndorf

{"title":"Accidental needlesticks: do anesthesiologists practice proper infection control precautions?","authors":"A D Rosenberg, D B Bernstein, R L Bernstein, M L Skovron, S Ramanathan, H Turndorf","doi":"","DOIUrl":"","url":null,"abstract":"Anesthesiologists as well as patients are at risk for acquiring blood-borne infections such as hepatitis and AIDS. We surveyed 2,530 anesthesiologists, a 10% random sample of the members of the American Society of Anesthesiologists, with a response rate of 57.1%, to determine the incidence of accidental needlestick exposure among anesthesia personnel and whether anesthesiologists are adhering to infection control guidelines to protect themselves and their patients from exposure to infectious diseases. Eighty-eight percent of respondents reported at least 1 accidental needlestick in the past 10 years; 21% received a needlestick from a high-risk patient and 4.5% a needlestick from a known HIV-positive patients. Residents reported significantly more accidental needlesticks from known HIV-positive patients (8.5%). Mucous membrane, open cut, eye, or other significant exposure to HIV-contaminated blood or body fluids was sustained by 8.34% of respondents in the past 10 years. Sixty percent of respondents reported they almost never reuse common syringes now compared with a 40.8% non-reuse rate (P < 0.001) in a similar survey on infection control practices conducted in 1990. Sixty-three percent reported they almost never reuse a vasopressor syringe compared with the 1990 non-reuse rate of 52.5% (P < 0.001). In the current survey, 39% of anesthesiologists reported reusing syringes from one patient to another and 36% reported reusing the same vasopressor syringes for different patients.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":80191,"journal":{"name":"The American journal of anesthesiology","volume":"22 3","pages":"125-32"},"PeriodicalIF":0.0,"publicationDate":"1995-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21022236","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}

引用次数: 0