{"title":"Striving to eliminate catheter-related bloodstream infections: A literature review of evidence-based strategies","authors":"Michael Rizzo","doi":"10.1053/j.sane.2005.10.001","DOIUrl":"10.1053/j.sane.2005.10.001","url":null,"abstract":"<div><p>This report has three objectives. First, to provide a concise summary of the current state of mandatory reporting legislation on nosocomial infection rates. Second, to identify and briefly summarize the evidence-based patient safety practices shown to reduce catheter-related bloodstream infections. And, finally, to demonstrate the significant cost benefit hospitals may achieve by undertaking programs to prevent these device-associated infections. Specifically, the following topics are addressed: public policy, prevention strategies and their clinical impact, role of technology, and economic implications.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Pages 214-225"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115759027","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":"Multimodality neuromonitoring for perioperative brain protection","authors":"Harvey L. Edmonds Jr PhD","doi":"10.1053/j.sane.2005.10.004","DOIUrl":"10.1053/j.sane.2005.10.004","url":null,"abstract":"<div><p>Perioperative brain injury is unfortunately a common occurrence. A large body of evidence indicates that the two major causes of this injury are embolism and a mismatch between regional cerebral oxygen supply and demand. Multimodality neuromonitoring detects these developing signs of injury and assesses the effectiveness of corrective action. Three non-invasive modalities continuously measure (1) embolism and cerebral blood flow change using transcranial Doppler ultrasound, (2) regional cerebral oxygen balance with transcranial near-infrared spectroscopy, and (3) functional change in cerebral cortical synaptic activity via EEG. When guided by standardized intervention protocols, neuromonitoring reduces neurologic injury and hospital costs.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Pages 186-194"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"100032464","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":"Role of brain function monitoring in the critical care and perioperative settings","authors":"Michael A.E. Ramsay MD (FRCA)","doi":"10.1053/j.sane.2005.10.002","DOIUrl":"10.1053/j.sane.2005.10.002","url":null,"abstract":"<div><p>The routine monitoring of brain function is not universal in the critical care or perioperative setting, yet consciousness and mental wellbeing are as important if not more important than cardiac performance and other major organ functions that are monitored intensively. The electrical activity generated by the cerebral cortex may be affected by cerebral perfusion<span><span>, hypoxia, and the effect of sedative and anesthetic pharmacological agents, seizure activity, </span>cerebral metabolism, and neuronal dysfunction. Instruments for monitoring brain function include subjective measures, such as assessment scoring systems, and objective measures that assess cerebral cortical activity. These objective measures focus primarily on the electrical activity of the cerebral cortex and correlate the power of the electrical signals with cerebral function. The available monitors utilize the actual signal frequency, power, or disorder and relate these data through various algorithms to the depth of sedation that the patient has attained. The success for these monitors in measuring the depth of sedation with consistency is dependent on the medications and combinations of medications administered, the algorithm developed, and the suppression of extraneous noise. Many studies have analyzed the effectiveness of using cerebral function monitors not only to guide depth of sedation, but to prevent unintended awareness in the paralyzed patient. The real value of these monitors may well be in improving patient safety by detecting cerebral insults early, allowing appropriate intervention to be made, and predicting outcome.</span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Pages 195-202"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115790874","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":"Topics in Sem Anesth","authors":"","doi":"10.1053/S0277-0326(05)00061-9","DOIUrl":"https://doi.org/10.1053/S0277-0326(05)00061-9","url":null,"abstract":"","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Page iii"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/S0277-0326(05)00061-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136593997","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":"Topics in Sem Anesth","authors":"","doi":"10.1053/S0277-0326(05)00039-5","DOIUrl":"https://doi.org/10.1053/S0277-0326(05)00039-5","url":null,"abstract":"","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 3","pages":"Page iii"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/S0277-0326(05)00039-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136557282","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":"Anesthesia machine basics","authors":"James B. Eisenkraft MD","doi":"10.1053/j.sane.2005.07.002","DOIUrl":"10.1053/j.sane.2005.07.002","url":null,"abstract":"<div><p><span>The anesthesia machine is that component of the anesthesia delivery system that receives medical gases (oxygen, </span>nitrous oxide<span>, air, heliox) under pressure and controls the flow of each gas individually. It creates a gas mixture of known composition at a known flow rate and delivers it to the common gas outlet of the machine. From here, the fresh gas flow is conducted to the anesthesia circle breathing system. This review will discuss the storage of compressed oxygen and nitrous oxide and how these gases arrive to a generic anesthesia machine. The paths taken by these gases as they flow through the generic machine will be described. The important components used to create the precisely controlled fresh gas mixture, as well as the safety features of the machine will also be described. The reader should gain an understanding of the machine basics that he/she can use to understand his/her particular model of machine.</span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 3","pages":"Pages 138-146"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128838164","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":"Muscle Relaxants 2006: a clinical and basic science update and commentary","authors":"Chingmuh Lee MD , Ronald L. Katz MD","doi":"10.1053/j.sane.2005.07.004","DOIUrl":"10.1053/j.sane.2005.07.004","url":null,"abstract":"<div><p>As muscle relaxants<span><span> remain a mainstay of modern anesthesia practice, it behooves the anesthesiologists to keep themselves up-to-date on the theory and clinical practice of neuromuscular pharmacology. Progress continues to be made in the basic and clinical aspects of neuromuscular pharmacology, including mechanism of action, blocking drugs, and reversal agent. The new mechanism of action is based on the molecular shape of the relaxants. Although the so-called “ideal relaxant” is still not in sight, and may never be, the new relaxant AV430A and the new reversal agent </span>Org 25969<span><span> hold potential to significantly improve patient care. AV430 has superior clinical profile, although it is still considerably slower and longer in action than succinylcholine. The fast onset of </span>rocuronium combined with its complete and immediate reversibility with Org 25969 may match succinylcholine in onset and offset. Both drugs are undergoing clinical trials.</span></span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 3","pages":"Pages 154-164"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115316065","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":"Opioids for pain: risk management","authors":"Steven H. Richeimer MD","doi":"10.1053/j.sane.2005.07.005","DOIUrl":"https://doi.org/10.1053/j.sane.2005.07.005","url":null,"abstract":"<div><p>The treatment of our patients’ pain has become a medical-legal minefield. We are getting sued for over-prescribing pain medications as well as for under-prescribing. Furthermore, the regulatory agencies are watching over our shoulders, ever vigilant for improper or fraudulent prescribing. Physicians must treat their patients’ pain, but this should be done in combination with thorough assessments, patient education, informed consents, complete documentation, use of consultants, carefully managed risk of addiction, and back-up emergency call systems. These preventive measures can help reduce the practitioner’s risk of suffering a medical-legal action.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 3","pages":"Pages 165-169"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92080358","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":"Medical directorship of anesthesia services: are you a player… or are you just being played?","authors":"Mark F. Weiss JD","doi":"10.1053/j.sane.2005.07.001","DOIUrl":"https://doi.org/10.1053/j.sane.2005.07.001","url":null,"abstract":"<div><p>Hospital CEOs often propose that a particular anesthesiologist, often the chairperson of the anesthesia department, serve as the “medical director” of anesthesia services with the duty of coordinating, and assuring, anesthesia coverage in the absence of an exclusive contract. This article discusses the differences between a simple medical directorship and an exclusive contract and exposes the risks that must be considered by a prospective medical director before accepting the position.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 3","pages":"Pages 170-172"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92036356","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}