Journal of anesthesia & clinical research最新文献

{"title":"Anesthetic Management of Double Atrial Septal Defect with Moderate Pulmonary Hypertension Emergency Caesarean Section","authors":"B. Kumar, S. Soni, A. Jafra","doi":"10.4172/2155-6148.1000876","DOIUrl":"https://doi.org/10.4172/2155-6148.1000876","url":null,"abstract":"Atrial septal defect (ASD) is common congenital heart disease in adults. Most of the cases are detected in childhood, whereas few cases reach adulthood undiagnosed. It is the most common congenital heart lesion in child bearing age group girls. ASD leads to various complications depending upon size, position of ASD and shunt flow direction and hemodynamic change. Pulmonary artery hypertension is one such complication which occurs due to large blood flow across pulmonary artery due to left to right shunting. Pulmonary hypertension is defined as a mean pulmonary arterial pressure greater than 25 mm Hg at rest or greater than 30 mmHg during exercise. We reported a case of double ASD of size 10 mm and 5 mm with moderate pulmonary artery hypertension which underwent emergency caesarean section for meconium stained liquor. Under all aseptic precaution epidural catheter was placed at L3-4 level in sitting position by loss of resistance technique and then spinal anesthesia was given at the same level with 26G needle. Total drug given in spinal was 2.5 ml which includes 2 ml of bupivacaine (heavy) and 0.5 ml fentanyl. The patient was managed successfully under regional (epidural with low dose spinal) anesthesia without facing any complication. During anesthesia our main aim was to prevent complications, like hypotension, hypoxia, hypercarbia, reversal of shunt, fluid overload and maintain systemic pulmonary vascular resistance. As these complications adversely affect the outcome in heart disease patients.","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70278972","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":"Feasibility of Spinal Anesthesia Placement Using Automated Interpretation of Lumbar Ultrasound Images: A Prospective Randomized Controlled Trial.","authors":"Priyanka Singla,&nbsp;Adam J Dixon,&nbsp;Jessica L Sheeran,&nbsp;David Scalzo,&nbsp;Frank W Mauldin,&nbsp;Mohamed Tiouririne","doi":"10.4172/2155-6148.1000878","DOIUrl":"https://doi.org/10.4172/2155-6148.1000878","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the efficacy of spinal anesthesia administration by resident physicians when using an ultrasound system with automated neuraxial landmark detection capabilities.</p><p><strong>Methods: </strong>150 patients were enrolled in this trial. Anesthesiology residents placed spinals in subjects undergoing scheduled cesarean delivery using one of three techniques to identify neuraxial landmarks: palpation, ultrasound, or combined palpation and ultrasound. Ultrasound was performed using a handheld system that automatically identified neuraxial landmarks (e.g. midline, intervertebral spaces). All residents watched a 10-minute video and received 20 minutes of hands-on training prior to participating in the study. First insertion success rate was the primary end point.</p><p><strong>Results: </strong>Among all patients, use of ultrasound resulted in a 11% greater first-insertion success rate (RR: 1.11 [0.85-1.47], p=0.431), a 15% reduction in needle insertions (RR: 0.85, p=0.052), and a 26% decrease in needle passes (RR: 0.74, p=0.070). In obese patients of BMI ≥ 30 kg/m², use of ultrasound resulted in 26% greater first-insertion success rates (RR: 1.26, p=0.187), a 21% decrease in needle insertions (RR: 0.79, p=0.025), a 38% decrease in needle passes (RR: 0.62, p=0.030), and a 75% decrease in patients reporting neutral or low patient satisfaction with anesthesia administration (RR: 0.25, p=0.004).</p><p><strong>Discussion: </strong>Resident anesthesiologists competently utilized the ultrasound system after receiving minimal training. Technical endpoints and patient satisfaction trended towards improvement when ultrasound was used prior to spinal placement, with stronger trends observed in obese patients. Additional study is required to fully characterize the impact of the ultrasound system on clinical efficacy.</p>","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"10 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-6148.1000878","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37313556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Postgraduates Following Implementation of a Focus Assessed Transthoracic Echocardiography (FATE) Training Course-A Pilot Study.","authors":"Stephen C Haskins,&nbsp;Jinhui Zhao,&nbsp;Jemiel A Nejim,&nbsp;Kara Fields,&nbsp;Sean Garvin,&nbsp;Sumudu Dehipawala,&nbsp;James D Beckman,&nbsp;Angie Zhang,&nbsp;James A Osorio,&nbsp;Christopher Tanaka","doi":"10.4172/2155-6148.1000763","DOIUrl":"https://doi.org/10.4172/2155-6148.1000763","url":null,"abstract":"<p><p>At our institution, implementation of a formal training course in Basic Focus Assessed Transthoracic Echocardiography (FATE) was associated with an improvement in anesthesia trainees' ability to obtain transthoracic echocardiography (TTE) images. Total image acquisition scores improved by a median (Q1, Q3) 9.1 (2.9,14.7) percentage points from pre-to post-hands-on FATE course (n=20; p=0.001). Participants who returned for a subsequent assessment 5 months following the course demonstrated a median (Q1, Q3) 18.0 (9.1,22.1) percentage point improvement from their pre-course total image acquisition scores (n=11; p=0.002). This pilot study established the feasibility of our program and results suggest that the basic FATE course can be used to teach trainees TTE quickly, effectively, and with significant retention.</p>","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"8 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-6148.1000763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35545990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Different Communication Tools on the Efficiency of Anesthesiologists in the Perioperative Setting.","authors":"Cindy Yeoh,&nbsp;Kay See Tan,&nbsp;Jennifer Mascarenhas,&nbsp;Luis Tollinche","doi":"10.4172/2155-6148.1000794","DOIUrl":"https://doi.org/10.4172/2155-6148.1000794","url":null,"abstract":"<p><strong>Objective: </strong>To assess if Real Time Locating Systems (RTLS) technology has an effect on the perioperative efficiency of anesthesiologists at our institution.</p><p><strong>Methods: </strong>A retrospective chart review was performed for all outpatient and short-stay patients who received general anesthesia and monitored anesthesia care between January and June of 2016. Patients over 18 years with an ASA classification of 1, 2, and 3 were included. Time was used as a measure of efficiency between two groups of anesthesiologists.These two comparison groups were as follows: <b>Group 1:</b> Anesthesiologists at the academic center's main campus who do not have access to RTLS<b>Group 2:</b> Anesthesiologists at Josie Robertson Ambulatory Surgical Center where RTLS is available and use of RTLS is compulsoryTwo outcome measures were collected from patient electronic records: <b>DUR1:</b> Duration between when patient is admitted to a presurgical bed and preoperative evaluation by the attending anesthesiologist<b>DUR2:</b> Duration between when patient is admitted to the operating room and initiation of induction by the attending anesthesiologist.</p><p><strong>Results: </strong>Anesthesiologists who had access to RTLS technology were found to be more efficient in completing their preoperative anesthesia evaluation and initiating intraoperative induction. They took less time to complete these tasks and the difference was statistically significant to p<0.0001.</p><p><strong>Conclusion: </strong>Anesthesiologists at our institution, who have access to RTLS as an additional communication tool, were found to be consistently more efficient in their perioperative workflow. There are confounding factors that can account for the shorter times and more efficient perioperative workflow of anesthesiologists. With continued application and investigation over time, the utility of RTLS on workflow efficiency of healthcare providers will become more apparent.</p>","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"8 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-6148.1000794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35791984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain.","authors":"Enas Kandil,&nbsp;Emily Melikman,&nbsp;Bryon Adinoff","doi":"10.4172/2155-6148.1000697","DOIUrl":"https://doi.org/10.4172/2155-6148.1000697","url":null,"abstract":"<p><p>Opioid abuse is a national epidemic in the United States, where it is estimated that a prescription drug overdose death occurs every 19 minutes. While opioids are highly effective in acute and subacute pain control, their use for treatment of chronic pain is controversial. Chronic opioids use is associated with tolerance, dependency, hyperalgesia. Although there are new strategies and practice guidelines to reduce opioid dependence and opioid prescription drug overdose, there has been little focus on development of opioid-sparing therapeutic approaches. Lidocaine infusion has been shown to be successful in controlling pain where other agents have failed. The opioid sparing properties of lidocaine infusion added to its analgesic and antihyperalgesic properties make lidocaine infusion a viable option for pain control in opioid dependent patients. In this review, we provide an overview of the opioid abuse epidemic, and we outline current evidence supporting the potential use of lidocaine infusion as an adjuvant therapeutic approach for management of chronic pain.</p>","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-6148.1000697","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34765859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Hypotensive Epidural Anesthesia on Distal and Proximal Tissue Perfusion in Patients Undergoing Total Hip Arthroplasty.","authors":"Thomas Danninger,&nbsp;Ottokar Stundner,&nbsp;Yan Ma,&nbsp;James J Bae,&nbsp;Stavros G Memtsoudis","doi":"10.4172/2155-6148.1000366","DOIUrl":"https://doi.org/10.4172/2155-6148.1000366","url":null,"abstract":"<p><p>Little data exists to detail the effect of hypotensive epidural anesthesia on differential tissue oxygenation changes above and below the level of neuraxial blockade. This study was designed to investigate tissue oxygenation in a clinical setting, using non-invasive near-infrared spectroscopy.</p><p><strong>Methods: </strong>Patients aged 18 to 85 years scheduled to undergo primary total hip arthroplasty were enrolled. Muscle oxygenation saturation was measured above and below the level of neuraxial blockade (deltoid and vastus lateralis muscles). Other continuously recorded parameters included cardiac output, stroke volume, heart rate, invasive mean arterial blood pressure and arterial oxygen saturation. Recordings of muscle oxygenation were compared over time separately for upper and lower extremity.</p><p><strong>Results: </strong>10 patients were enrolled. We found an intermittent and significant unadjusted decline of mean muscle oxygenation saturation in the vastus lateralis muscle during first part of the surgery (nadir 2^nd quintile: 71.0% vs. 63.3%, p<0.0001). This decline was followed by a return to baseline towards the end of the surgery (71.0% vs. 69.1%, p=0.3429). Mean muscle oxygenation saturation did not change for the same period of time in the deltoid muscle. When adjusting for covariates, the changes in muscle tissue oxygenation remained significant.</p><p><strong>Conclusion: </strong>These results indicate that muscle oxygenation saturation, a surrogate parameter for tissue perfusion, is decreased by hypotensive epidural anesthesia, but only within the functional limits of the neuraxial blockade. The etiology of these findings remains to be elucidated.</p>","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"4 11","pages":"366"},"PeriodicalIF":0.0,"publicationDate":"2013-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32147950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Pain Management for Patients on Chronic Buprenorphine: A Case Report.","authors":"Sy-Yeu S Chern,&nbsp;Rebecca Isserman,&nbsp;Linda Chen,&nbsp;Michael Ashburn,&nbsp;Renyu Liu","doi":"10.4172/2155-6148.1000250","DOIUrl":"https://doi.org/10.4172/2155-6148.1000250","url":null,"abstract":"<p><p>Here we present a patient with a Type I Chiari malformation who was receiving buprenorphine for chronic pain who underwent two separate urogynecologic procedures for removal of vaginal mesh with two different pain management regimens. For the first procedure at an outside hospital, the patient's usual dose of buprenorphine (8 mg sublingual every 8 hours) was continued up through her surgery and then a full opioid receptor agonist was used for postoperative pain management. The patient complained that this resulted in very poor pain control for her in the postoperative period. Prior to her second procedure, which was performed at our institution, buprenorphine was switched to a full opioid agonist (oral hydromorphone 4 mg every 4 to 6 hours, maximum 20 mg per day) for 5 days prior to surgery; postoperative pain was managed with full opioid receptor agonists. The patient again reported suboptimal pain control in spite of substantially increased doses of opioids. This case report highlights the difficulty of perioperative pain management for patients on chronic buprenorphine and emphasizes the need for additional investigation.</p>","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"3 250","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-6148.1000250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31929227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative Pressure Pulmonary Edema after Laryngospasm: A Revisit with a Case Report.","authors":"Lourdes Al Ghofaily,&nbsp;Courtney Simmons,&nbsp;Linda Chen,&nbsp;Renyu Liu","doi":"10.4172/2155-6148.1000252","DOIUrl":"https://doi.org/10.4172/2155-6148.1000252","url":null,"abstract":"Laryngospasm, a brief closure of the vocal cords is not an uncommon perioperative occurrence. If recognized and managed appropriately, the effects are transient and reversible. However, in rare cases where recognition and management are delayed, the consequences are associated with a high morbidity including desaturation, awareness, negative pressure pulmonary edema, and mortality. This case highlights that of a healthy woman admitted the intensive care unit (ICU) for negative pressure pulmonary edema (NPPE) after an episode of laryngospasm.","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"3 10","pages":"252"},"PeriodicalIF":0.0,"publicationDate":"2013-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-6148.1000252","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32112902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updates on Hepato-Renal Syndrome.","authors":"Kyota Fukazawa,&nbsp;H Thomas Lee","doi":"10.4172/2155-6148.1000352","DOIUrl":"https://doi.org/10.4172/2155-6148.1000352","url":null,"abstract":"<p><p>Hepato-renal syndrome (HRS) is one of the most detrimental conditions in patients with end stage liver failure. Historically, HRS was considered a terminal disease associated with cirrhosis and was termed \"liver-death syndrome\". Furthermore, despite the improved understanding of pathophysiology and the reversibility of renal dysfunction in HRS, mortality remains extremely high especially for type 1 HRS. This review summarizes the recent advances in the pathophysiology, diagnosis and management of HRS and also provides an evolving area of research in the pathophysiologic mechanisms of HRS, which may open the door for new therapeutic approaches.</p>","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"4 9","pages":"352"},"PeriodicalIF":0.0,"publicationDate":"2013-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-6148.1000352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32057743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center.","authors":"W. Xue, Zhe Yan, R. Barnett, L. Fleisher, Renyu Liu","doi":"10.4172/2155-6148.1000314","DOIUrl":"https://doi.org/10.4172/2155-6148.1000314","url":null,"abstract":"BACKGROUND\u0000Unexpected surgical cancellation is common and can have significant adverse effects. Cancellation rates vary because of a lack of a standard definition, different patient populations and study methodology. We hypothesized that case cancellation has a different pattern in a dedicated ambulatory surgical center compared to a general operating room (OR) setting in a large academic center without an anesthesia preoperative evaluation center necessitating evaluation by the various surgeons.\u0000\u0000\u0000METHODS\u0000Elective cases in general OR and in the ambulatory surgical center were included in this study. Elective cases are defined as the non-emergent cases scheduled before 8:00 am on the day of surgery. A cancelled case was defined as a scheduled procedure which is not performed on the scheduled procedure day. Case cancellation was monitored in real time using an electronic patient flow system (Navicare). As soon as the case is cancelled, the reason for the cancellation was obtained from the surgeon, the anesthesiologist, the OR coordinated nurses and/or the floor nurse. In the day surgical center, the cancelled cases were followed to determine whether/when they were rescheduled.\u0000\u0000\u0000RESULTS\u00004261 elective cases were included in this investigation, including 2751 cases in the general OR and 1510 cases in the ambulatory surgical center. A total of 283 cases (6.6%) were cancelled which include 206 cases from the general OR and 77 from the ambulatory surgical center. The cancellation rate in the general OR was 7.5%, among which inpatients have the highest cancellation rate of 18.1%, followed by outpatients at 4.6%, and same day admission at the lowest cancellation rate of 2.0%. The top 3 reasons for cancellation in general OR werein adequate preoperative preparation 29.4 ± 4.5%, medical condition change 28.5 ± 10.2%; and scheduling issue 20.2 ± 7.1%. Most (59.2 ± 8.9%) of the cancellations was considered preventable, 12.3 ± 5.9% was considered potentially preventable, and 28.5 ± 10.2% were not preventable (such as patient condition changes). The cancellation rate in the ambulatory surgical center was 5.1%. The major reason for cancellation was patient no show 75.8 ± 5.2 %, 61% of those no show patients were rescheduled and the mean delay in surgery was 18 days (range from 1 day to 84 days).\u0000\u0000\u0000CONCLUSIONS\u0000Case cancellation is not un-common in a large academic center without a preoperative evaluation clinic. The dynamics of case cancellation are different in an ambulatory surgical center as compared to the general OR. Inpatients have the highest cancellation rate associated with inadequate preoperative preparation and scheduling, this should be preventable via adopting proper systems of evaluation and preparation. Most of the case cancellations in the ambulatory surgical center are from patient no show, suggesting that administrative strategies to reduce this issue should be implemented. The patients admitted on the same day of surgery had the lowest cancell","PeriodicalId":89794,"journal":{"name":"Journal of anesthesia & clinical research","volume":"4 5 1","pages":"314"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70278724","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}