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Using Amsorb to detect dehydration of CO2 absorbents containing strong base | Background: Because Amsorb changes color when it dries, the authors investigated whether Amsorb combined with different strong base-containing carbon dioxide absorbents signals dehydration of such absorbents. Methods: Five different carbon dioxide absorbents (1,330 g) each topped with 70 g of Amsorb were dried in an an... |
Changing anesthesiologists' practice patterns: Can it be done? | Background: Because the ultimate purpose of new medical knowledge is to achieve improved health outcomes, physicians need to possess and use this knowledge in their practice. The authors introduced enhanced education and individualized feedback to reduce postoperative nausea and vomiting (PONY). The primary objective w... |
Anesthesiologist board certification and patient outcomes | Background: Board certification is often used as a surrogate indicator of provider competence, although few outcome studies have demonstrated its validity. The aim of this study was to compare the outcomes of patients who underwent surgical procedures under the care of an anesthesiologist with or without board certific... |
Neuroprotective effects of dexmedetomidine against glutamate agonist-induced neuronal cell death are related to increased astrocyte brain-derived neurotrophic factor expression | Background: Brain-derived neurotrophic factor (BDNF) plays a prominent role in neuroprotection against perinatal brain injury. Dexmedetomidine, a selective agonist of α2-adrenergic receptors, also provides neuroprotection against glutamate-induced damage. Because adrenergic receptor agonists can modulate BDNF expressio... |
Buprenorphine disrupts sleep and decreases adenosine concentrations in sleep-regulating brain regions of sprague dawley rat | Background: Buprenorphine, a partial μ-opioid receptor agonist and κ-opioid receptor antagonist, is an effective analgesic. The effects of buprenorphine on sleep have not been well characterized. This study tested the hypothesis that an antinociceptive dose of buprenorphine decreases sleep and decreases adenosine conce... |
High incidence of burnout in academic chairpersons of anesthesiology: Should we be taking better care of our leaders? | Background: Burnout is a work-related psychologic syndrome characterized by emotional exhaustion, low personal accomplishment, and depersonalization. Methods: By using an instrument that included the MBI-HHS Burnout Inventory, we surveyed academic anesthesiology chairpersons in the United States. Current level of job s... |
Adora2b signaling on bone marrow derived cells dampens myocardial ischemia-reperfusion injury | Background: Cardiac ischemia-reperfusion (I-R) injury represents a major cause of cardiac tissue injury. Adenosine signaling dampens inflammation during cardiac I-R. The authors investigated the role of the adenosine A2b-receptor (Adora2b) on inflammatory cells during cardiac I-R. Methods: To study Adora2b signaling on... |
Role of the o-linked β-N-acetylglucosamine in the cardioprotection induced by isoflurane | Background: Cardiac protection by volatile anesthetic-induced preconditioning and ischemic preconditioning have similar signaling pathways. Recently, it was reported that augmentation of protein modified with O-linked β-N-acetylglucosamine (O-GlcNAc) contributes to cardiac protection. This study investigated the role o... |
Anesthesiology trainees face ethical, practical, and relational challenges in obtaining informed consent | BACKGROUND: Categorizing difficulties anesthesiologists have in obtaining informed consent may influence education, performance, and research. This study investigated the trainees perspectives and educational needs through a qualitative analysis of narratives. METHODS: The Program to Enhance Relational and Communicatio... |
Celecoxib impairs heart development via inhibiting cyclooxygenase-2 activity in zebrafish embryos | Background: Celecoxib, a cyclooxygenase-2 inhibitor, is a commonly ingested drug that is used by some women during pregnancy. Although use of celecoxib is associated with increased cardiovascular risk in adults, its effect on fetal heart development remains unknown. Methods: Zebrafish embryos were exposed to celecoxib ... |
Do they understand? (Part I): Parental consent for children participating in clinical anesthesia and surgery research | Background: Central to the tenet of informed consent is the quality of disclosure of information by the investigator and the understanding thereof by the research subject or his or her surrogate. This study was designed to measure parents' understanding of the elements of informed consent for clinical studies in which ... |
A single subanesthetic dose of ketamine relieves depression-like behaviors induced by neuropathic pain in rats | Background: Chronic pain is associated with depression. In rodents, pain is often assessed by sensory hypersensitivity, which does not sufficiently measure affective responses. Low-dose ketamine has been used to treat both pain and depression, but it is not clear whether ketamine can relieve depression associated with ... |
Resident characterization of better-than- and worse-than-average clinical teaching | Background: Clinical teachers and trainees share a common view of what constitutes excellent clinical teaching, but associations between these behaviors and high teaching scores have not been established. This study used residents' written feedback to their clinical teachers, to identify themes associated with above- o... |
General anesthesia causes long-term impairment of mitochondrial morphogenesis and synaptic transmission in developing rat brain | Background: Clinically used general anesthetics, alone or in combination, are damaging to the developing mammalian brain. In addition to causing widespread apoptotic neurodegeneration in vulnerable brain regions, exposure to general anesthesia at the peak of synaptogenesis causes learning and memory deficiencies later ... |
Strategy-dependent dissociation of the neural correlates involved in pain modulation | Background: Cognitive strategies are a set of psychologic behaviors used to modulate one's perception or interpretation of a sensation or situation. Although the effectiveness of each cognitive strategy seems to differ between individuals, they are commonly used clinically to help patients with chronic pain cope with t... |
New Setting of Neurally Adjusted Ventilatory Assist during Noninvasive Ventilation through a Helmet | Background: Compared to pneumatically controlled pressure support (PSP), neurally adjusted ventilatory assist (NAVA) was proved to improve patient-ventilator interactions, while not affecting comfort, diaphragm electrical activity (EAdi), and arterial blood gases (ABGs). This study compares neurally controlled pressure... |
Compassionate and Clinical Behavior of Residents in a Simulated Informed Consent Encounter | BACKGROUND: Compassionate behavior in clinicians is described as seeking to understand patients' psychosocial, physical and medical needs, timely attending to these needs, and involving patients as they desire. The goal of our study was to evaluate compassionate behavior in patient interactions, pain management, and th... |
Regional and gender differences and trends in the anesthesiologist workforce | Background: Concerns have long existed about potential shortages in the anesthesiologist workforce. In addition, many changes have occurred in the economy, demographics, and the healthcare sector in the last few years, which may impact the workforce. The authors documented workforce trends by region of the United State... |
Sites Related to Crawford Williamson Long in Georgia | Background: Crawford Williamson Long (1815 to 1878) was the first to use ether as an inhaled anesthetic for surgical operations. By not publishing his discovery for 7 yr, his pioneering work was largely overshadowed by that of Horace Wells (1815 to 1848), Charles Thomas Jackson (1805 to 1880), and William Thomas Green ... |
Standard Setting for Clinical Performance of Basic Perioperative Transesophageal Echocardiography: Moving beyond the Written Test | Background: Credible methods for assessing competency in basic perioperative transesophageal echocardiography examinations have not been reported. The authors' objective was to demonstrate the collection of real-world basic perioperative transesophageal examination performance data and establish passing scores for each... |
Propofol restores transient receptor potential vanilloid receptor subtype-1 sensitivity via activation of transient receptor potential ankyrin receptor subtype-1 in sensory neurons | Background: Cross talk between peripheral nociceptors belonging to the transient receptor potential vanilloid receptor subtype-1 (TRPV1) and ankyrin subtype-1 (TRPA1) family has been demonstrated recently. Moreover, the intravenous anesthetic propofol has directly activates TRPA1 receptors and indirectly restores sensi... |
Predicting success on the certification examinations of the american board of anesthesiology | Background: Currently, residency programs lack objective predictors for passing the sequenced American Board of Anesthesiology (ABA) certification examinations on the first attempt. Our hypothesis was that performance on the ABA/American Society of Anesthesiologists In-Training Examination (ITE) and other variables can... |
Midazolam suppresses maturation of murine dendritic cells and priming of lipopolysaccharide-induced t helper 1-type immune response | Background: Dendritic cells (DCs), as antigen-presenting cells, play a key role in the induction and regulation of adaptive immune response. Midazolam is reported to have immunomodulatory properties that affect immune cells. However, the effect of midazolam on DCs has not been characterized. We examined the immunomodul... |
Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients | Background: Despite its widespread use, the American Society of Anesthesiologists (ASA)-Physical Status Classification System has been shown to result in inconsistent assignments among anesthesiologists. The ASA-Physical Status Classification System is also used by nonanesthesia-trained clinicians and others. In 2014, ... |
Establishing obstetric anesthesiology practice guidelines in the Republic of Armenia: A global health collaboration | Background: Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines ma... |
Acquisition of critical intraoperative event management skills in novice anesthesiology residents by using high-fidelity simulation-based training | Background: Early acquisition of critical competencies by novice anesthesiology residents is essential for patient safety, but traditional training Methods may be insufficient. The purpose of this study was to determine the effectiveness of high-fidelity simulation training of novice residents in the initial management... |
Building the evidence on simulation validity: Comparison of anesthesiologists' communication patterns in real and simulated cases | Background: Effective teamwork is important for patient safety, and verbal communication underpins many dimensions of teamwork. The validity of the simulated environment would be supported if it elicited similar verbal communications to the real setting. The authors hypothesized that anesthesiologists would exhibit sim... |
Impact of entropy monitoring on volatile anesthetic uptake | Background: Electroencephalogram-derived monitoring to assess anesthetic depth may allow more accurate hypnotic drug administration, resulting in decreased anesthetic drug consumption. The authors hypothesized that the use of M-Entropy monitoring (Datex-Ohmeda, Helsinki, Finland) is associated with reduced sevoflurane ... |
The effect of electronic record keeping and transesophageal echocardiography on task distribution, workload, and vigilance during cardiac anesthesia | Background: Electronic anesthesia record keeping (EARK) systems increasingly are used in the operating room, but studies have only recently begun to investigate their effect on anesthesia task performance. Task analysis, workload assessment, and vigilance assessment techniques were used to study senior residents provid... |
Simulation-based assessment and retraining for the anesthesiologist seeking reentry to clinical practice a case series | Background: Established models for assessment and maintenance of competency in anesthesiology may not be adequate for anesthesiologists wishing to reenter practice. The authors describe a program developed in their institution incorporating simulator-based education, to help determine competency in licensed and previou... |
Reporting of Ethical Approval and Informed Consent in Clinical Research Published in Leading Anesthesia Journals | Background: Ethical conduct in human research in anesthesia includes approval by an institutional review board (IRB) or ethics committee and informed consent. Evidence of these is sometimes lacking in journal publications. Methods: The authors reviewed all publications involving human subjects in six leading anesthesia... |
Two etomidate sites in α1β2γ2 γ-aminobutyric acid type a receptors contribute equally and noncooperatively to modulation of channel gating | Background: Etomidate is a potent hypnotic agent that acts via γ-aminobutyric acid receptor type A (GABAA) receptors. Evidence supports the presence of two etomidate sites per GABAA receptor, and current models assume that each site contributes equally and noncooperatively to drug effects. These assumptions remain unte... |
Closed-loop continuous infusions of etomidate and etomidate analogs in rats: A comparative study of dosing and the impact on adrenocortical function | Background: Etomidate is a sedative-hypnotic that is often given as a single intravenous bolus but rarely as an infusion because it suppresses adrenocortical function. Methoxycarbonyl etomidate and (R)-ethyl 1-(1-phenylethyl)-1H-pyrrole-2-carboxylate (carboetomidate) are etomidate analogs that do not produce significan... |
Does Iso-mechanical Power Lead to Iso-lung Damage? An Experimental Study in a Porcine Model | Background: Excessive tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP) are all potential causes of ventilator-induced lung injury, and all contribute to a single variable: The mechanical power. The authors aimed to determine whether high tidal volume or high respiratory rate or high PEEP at i... |
ARA290, a peptide derived from the tertiary structure of erythropoietin, produces long-term relief of neuropathic pain: An experimental study in rats and β-common receptor knockout mice | Background: Exogenous erythropoietin inhibits development of allodynia in experimental painful neuropathy because of its antiinflammatory and neuroprotective properties at spinal, supraspinal, and possibly peripheral sites. The authors assess the effect of a nonhematopoietic erythropoietin analog, ARA290, on tactile an... |
Deleterious impact of a γ-aminobutyric acid type a receptor preferring general anesthetic when used in the presence of persistent inflammation | Background: Experimental data suggest general anesthetics preferring γ-aminobutyric acid receptor type A may increase postoperative pain in patients with persistent inflammation. The current study was designed to begin to test this hypothesis. Methods: Groups of rats were defined by the presence of inflammation, surgic... |
Variation in expert opinion in medical malpractice review | Background: Expert opinion in medical malpractice is a form of implicit assessment, based on unstated individual opinion. This contrasts with explicit assessment processes, which are characterized by criteria specified and stated before the assessment. Although sources of bias that might hinder the objectivity of exper... |
Facilitation of resident scholarly activity: Strategy and outcome analyses using historical resident cohorts and a rank-to-match population | Background: Facilitation of residents' scholarly activities is indispensable to the future of medical specialties. Research education initiatives and their outcomes, however, have rarely been reported.Methods: Since academic year 2006, research education initiatives, including research lectures, research problem-based ... |
Analysis of dynamic intratidal compliance in a lung collapse model | Background: For mechanical ventilation to be lung-protective, an accepted suggestion is to place the tidal volume (VT) between the lower and upper inflection point of the airway pressure-volume relation. The drawback of this approach is, however, that the pressure-volume relation is assessed under quasistatic, no-flow ... |
Adverse events with medical devices in anesthesia and intensive care unit patients recorded in the french safety database in 2005-2006 | Background: French regulations require that adverse events involving medical devices be reported to the national healthcare safety agency. The authors evaluated reports made in 2005-2006 for patients in anesthesiology and critical care. Methods: For each type of device, the authors recorded the severity and cause of th... |
Gabapentin inhibits γ-amino butyric acid release in the locus coeruleus but not in the spinal dorsal horn after peripheral nerve injury in rats | Background: Gabapentin reduces acute postoperative and chronic neuropathic pain, but its sites and mechanisms of action are unclear. Based on previous electrophysiologic studies, the authors tested whether gabapentin reduced γ-amino butyric acid (GABA) release in the locus coeruleus (LC), a major site of descending inh... |
An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia | Background: General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia-ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia ... |
Rapid eye movement sleep debt accrues in mice exposed to volatile anesthetics | Background: General anesthesia has been likened to a state in which anesthetized subjects are locked out of access to both rapid eye movement (REM) sleep and wakefulness. Were this true for all anesthetics, a significant REM rebound after anesthetic exposure might be expected. However, for the intravenous anesthetic pr... |
Early exposure to general anesthesia disturbs mitochondrial fission and fusion in the developing rat brain | Background: General anesthetics induce apoptotic neurodegeneration in the developing mammalian brain. General anesthesia (GA) also causes significant disturbances in mitochondrial morphogenesis during intense synaptogenesis. Mitochondria are dynamic organelles that undergo remodeling via fusion and fission. The fine ba... |
Sevoflurane and Parkinson's Disease Subthalamic Nucleus Neuronal Activity and Clinical Outcome of Deep Brain Stimulation | Background: General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult. The authors hypothesized that while sevoflurane anesthesia entrains coherent lower frequency oscillations, it does not affect the identification of the subt... |
Redesign of the System for Evaluation of Teaching Qualities in Anesthesiology Residency Training (SETQ Smart) | Background: Given the increasing international recognition of clinical teaching as a competency and regulation of residency training, evaluation of anesthesiology faculty teaching is needed. The System for Evaluating Teaching Qualities (SETQ) Smart questionnaires were developed for assessing teaching performance of fac... |
Pharmacokinetics and clinical pharmacodynamics of the new propofol prodrug GPI 15715 in volunteers (Retraction in: Anesthesiology (2010) 112:4 (1056-1057)) | Background: GPI 15715 (AQUAVAN injection) is a new water-soluble prodrug which is hydrolyzed to release propofol. The objectives of this first study in humans were to investigate the safety, tolerability, pharmacokinetics, and clinical pharmacodynamics of GPI 15715. Methods: Three groups of three healthy male volunteer... |
Comparative pharmacokinetics and pharmacodynamics of the new propofol prodrug GPI 15715 and propofol emulsion (Retraction in: Anesthesiology (2010) 112:4 (1056-1057)) | Background: GPI 15715 is a new water-soluble prodrug that is hydrolyzed to release propofol. The objectives of this crossover study in volunteers were to investigate the pharmacokinetics and pharmacodynamics of GPI 15715 in comparison with propofol emulsion. Methods: In two separate sessions, nine healthy male voluntee... |
A Feedback and Evaluation System That Provokes Minimal Retaliation by Trainees | Background: Grade inflation is pervasive in educational settings in the United States. One driver of grade inflation may be faculty concern that assigning lower clinical performance scores to trainees will cause them to retaliate and assign lower teaching scores to the faculty member. The finding of near-zero retaliati... |
Local administration of morphine for analgesia after iliac bone graft harvest (Retraction in: Anesthesiology (2009) 110:3 (689)) | Background: Harvesting autogenous bone grafts from the ilium may cause considerable pain and may represent a significant source of postoperative morbidity. The local application of morphine can reduce pain in a rat model of bone damage. We evaluated the analgesic efficacy of administering morphine to the donor bone gra... |
Massive hemorrhage : A report from the anesthesia closed claims project | Background: Hemorrhage is a potentially preventable cause of adverse outcomes in surgical and obstetric patients. New understanding of the pathophysiology of hemorrhagic shock, including development of coagulopathy, has led to evolution of recommendations for treatment. However, no recent study has examined the legal o... |
Stress management training improves overall performance during critical simulated situations: A prospective randomized controlled trial | Background: High-fidelity simulation improves participant learning through immersive participation in a stressful situation. Stress management training might help participants to improve performance. The hypothesis of this work was that Tactics to Optimize the Potential, a stress management program, could improve resid... |
Distribution of epidural saline upon injection and the epidural volume effect in pregnant women | Background: How injected epidural solution is distributed and affects the epidural volume in pregnant women are unclear. Methods: Lumbar epidural catheters were placed using the loss-of-resistance technique with saline in eight full-term (39 weeks gestation) parturients for labor and eight volunteer nonpregnant women. ... |
Degrees of reality: Airway anatomy of high-fidelity human patient simulators and airway trainers | Background: Human patient simulators and airway training manikins are widely used to train airway management skills to medical professionals. Furthermore, these patient simulators are employed as standardized patients to evaluate airway devices. However, little is known about how realistic these patient simulators and ... |
Supervised Machine-learning Predictive Analytics for Prediction of Postinduction Hypotension | Background: Hypotension is a risk factor for adverse perioperative outcomes. Machine-learning methods allow large amounts of data for development of robust predictive analytics. The authors hypothesized that machine-learning methods can provide prediction for the risk of postinduction hypotension. Methods: Data was ext... |
Obstetric anesthesia work force survey, 1981 versus 1992 | Background: In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repe... |
Financial impact if payers use medicare rates: Anesthesiology versus other specialties | Background: In 1992, Medicare changed its method for calculating physician payments. The resulting fee schedules have contained low payments for anesthesiologists. Now, other third-party (insurance) payers are using these schedules. The financial impact on anesthesiologists if all payers pay Medicare rates is unknown. ... |
Association between performance in a maintenance of certification program and disciplinary actions against the medical licenses of anesthesiologists | Background: In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical l... |
Drug Enforcement Agency 2014 Hydrocodone Rescheduling Rule and Opioid Dispensing after Surgery | Background: In 2014, the U.S. Drug Enforcement Agency reclassified hydrocodone from Schedule III to Schedule II of the Controlled Substances Act, resulting in new restrictions on refills. The authors hypothesized that hydrocodone rescheduling led to decreases in total opioid dispensing within 30 days of surgery and red... |
Availability of Inpatient Pediatric Surgery in the United States | Background: In 2015, the American College of Surgeons began its Children's Surgery Verification Quality Improvement Program, promulgating standards intended to promote regionalization and improve pediatric surgical care. It was hypothesized that pediatric surgical care was already highly regionalized and concentrated b... |
Trends in Direct Hospital Payments to Anesthesia Groups: A Retrospective Cohort Study of Nonacademic Hospitals in California | BACKGROUND: In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments. Understanding the magnitude of these payments and their association with the hospitals' payer mixes has important policy implications. METHODS: Using a dataset of financial repor... |
Neonatal desflurane exposure induces more robust neuroapoptosis than do isoflurane and sevoflurane and impairs working memory | Background: In animal models, neonatal exposure to volatile anesthetics induces neuroapoptosis, leading to memory deficits in adulthood. However, effects of neonatal exposure to desflurane are largely unknown. Methods: Six-day-old C57BL/6 mice were exposed to equivalent doses of desflurane, sevoflurane, or isoflurane f... |
Isoflurane decreases self-renewal capacity of rat cultured neural stem cells | Background: In models, isoflurane produces neural and behavioral deficits in vitro and in vivo. This study tested the hypothesis that neural stem cells are adversely affected by isoflurane such that it inhibits proliferation and kills these cells. Methods: Sprague-Dawley rat embryonic neural stem cells were plated onto... |
Dexmedetomidine prevents cognitive decline by enhancing resolution of high mobility group box 1 protein-induced inflammation through a vagomimetic action in mice | Background: Inflammation initiated by damage-Associated molecular patterns has been implicated for the cognitive decline associated with surgical trauma and serious illness. We determined whether resolution of inflammation mediates dexmedetomidine-induced reduction of damage-Associated molecular pattern-induced cogniti... |
Comparing clinical productivity of anesthesiology groups | Background: Intergroup comparisons of clinical productivity are important for strategic planning and evaluation of clinical and business operations. However, in a preliminary study, comparisons of two anesthesiology groups using "per full-time equivalent" measurements were confounded by different concurrencies or staff... |
Predicting acute pain after cesarean delivery using three simple questions | Background: Interindividual variability in postoperative pain presents a clinical challenge. Preoperative quantitative sensory testing is useful but time consuming in predicting postoperative pain intensity. The current study was conducted to develop and validate a predictive model of acute postcesarean pain using a si... |
An algorithm for assessing intraoperative mean arterial pressure lability | Background: Intraoperative blood pressure liability may be related to risk factors, hypovolemia, light anesthesia, and morbid outcomes, but the measurements of lability in previous studies have been limited by imprecise and infrequent data collection methods. Computerized intraoperative data acquisition systems have pr... |
Transient Receptor Potential Vanilloid 1 Antagonists Prevent Anesthesia-induced Hypothermia and Decrease Postincisional Opioid Dose Requirements in Rodents | Background: Intraoperative hypothermia and postoperative pain control are two important clinical challenges in anesthesiology. Transient receptor potential vanilloid 1 has been implicated both in thermoregulation and pain. Transient receptor potential vanilloid 1 antagonists were not advanced as analgesics in humans in... |
S(+)-ketamine suppresses desensitization of γ-aminobutyric acid type B receptor-mediated signaling by inhibition of the interaction of γ-aminobutyric acid type B receptors with G protein-coupled receptor kinase 4 or 5 | Background: Intrathecal baclofen therapy is an established treatment for severe spasticity. However, long-term management occasionally results in the development of tolerance. One of the mechanisms of tolerance is desensitization of γ-aminobutyric acid type B receptor (GABABR) because of the complex formation of the GA... |
Source-level Cortical Power Changes for Xenon and Nitrous Oxide-induced Reductions in Consciousness in Healthy Male Volunteers | Background: Investigations of the electrophysiology of gaseous anesthetics xenon and nitrous oxide are limited revealing inconsistent frequencydependent alterations in spectral power and functional connectivity. Here, the authors describe the effects of sedative, equivalent, stepwise levels of xenon and nitrous oxide a... |
TASK channel deletion reduces sensitivity to local anesthetic-induced seizures | Background: Local anesthetics (LAs) are typically used for regional anesthesia but can be given systemically to mitigate postoperative pain, supplement general anesthesia, or prevent cardiac arrhythmias. However, systemic application or inadvertent intravenous injection can be associated with substantial toxicity, incl... |
Hospital stay and mortality are increased in patients having a triple low of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia | Background: Low mean arterial pressure (MAP) and deep hypnosis have been associated with complications and mortality. The normal response to high minimum alveolar concentration (MAC) fraction of anesthetics is hypotension and low Bispectral Index (BIS) scores. Low MAP and/or BIS at lower MAC fractions may represent ane... |
Influence of low tidal volume ventilation on time to extubation in cardiac surgical patients | Background: Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-ass... |
Double epidural catheter with ropivacaine versus intravenous morphine: A comparison for postoperative analgesia after scoliosis correction surgery | Background: Major spine surgery with a dorsal or ventrodorsal approach causes severe postoperative pain. The use of continuous epidural analgesia through one or two epidural catheters placed intraoperatively by the surgeon has been shown to provide efficient postoperative pain control. In this prospective unblinded stu... |
Initial experience of an anesthesiology-based service for perioperative management of pacemakers and implantable cardioverter defibrillators | Background: Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a smal... |
Where are the costs in perioperative care?: Analysis of hospital costs and charges for inpatient surgical care | Background: Many health-care institutions are emphasizing cost reduction programs as a primary tool for managing profitability. The goal of this study was to elucidate the proportion of anesthesia costs relative to perioperative costs as determined by charges and actual costs. Methods: Costs and charges for 715 inpatie... |
Laryngoscopic intubation: Learning and performance | Background: Many healthcare professionals are trained in direct laryngoscopic tracheal intubation (LEI), which is a potentially lifesaving procedure. This study attempts to determine the number of successful LEI exposures required during training to assure competent performance, with special emphasis on defining compet... |
Patterns of preoperative consultation and surgical specialty in an integrated healthcare system | Background: Many patients scheduled for elective surgery are referred for a preoperative medical consultation. Only limited data are available on factors associated with preoperative consultations. The authors hypothesized that surgical specialty contributes to variation in referrals for preoperative consultations. Met... |
Influence of patient comorbidities on the risk of near-miss maternal morbidity or mortality | Background: Maternal morbidity and mortality are increased in the United States compared with that of other developed countries. The objective of this investigation is to determine the extent to which it is possible to predict which patients will experience near-miss morbidity or mortality. Methods: The authors defined... |
A series of anesthesia-related maternal deaths in Michigan, 1985-2003 | BACKGROUND: Maternal Mortality Surveillance has been conducted by the State of Michigan since 1950, and anesthesia-related maternal deaths were most recently reviewed for the years 1972-1984. METHODS: Records for pregnancy-associated deaths between 1985 and 2003 were reviewed to identify 25 cases associated with a peri... |
Myocardial Function during Low versus Intermediate Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome | Background: Mechanical ventilation with low tidal volumes has the potential to mitigate ventilation-induced lung injury, yet the clinical effect of tidal volume size on myocardial function has not been clarified. This cross-sectional study investigated whether low tidal volume ventilation has beneficial effects on myoc... |
Using an anesthesia information management system as a cost containment tool: Description and validation | Background: Medical informatics provide a new way to evaluate the practice of medicine. Anesthesia automated record keepers have introduced anesthesiologists to computerized medical records. To derive useful information from the stored data requires programming that is not currently commercially available. The authors ... |
Malpractice claims associated with medication management for chronic pain | Background: Medication management is an integral part of chronic pain management. Prompted by an increase in the role of medication management in anesthesia chronic pain liability, we investigated the characteristics of malpractice claims collected from 2005 to 2008. METHODS:: After Institutional Review Board approval,... |
New insights into the mechanism of methoxyflurane nephrotoxicity and implications for anesthetic development (Part 2): Identification of nephrotoxic metabolites | BACKGROUND: Methoxyflurane nephrotoxicity results from its metabolism, which occurs by both dechlorination (to methoxydifluoroacetic acid [MDFA]) and O-demethylation (to fluoride and dichloroacetic acid [DCAA]). Inorganic fluoride can be toxic, but it remains unknown why other anesthetics, commensurately increasing sys... |
TT-301 inhibits microglial activation and improves outcome after central nervous system injury in adult mice | Background: Microglial inhibition may reduce secondary tissue injury and improve functional outcome following acute brain injury. Utilizing clinically relevant murine models of traumatic brain injury and intracerebral hemorrhage, neuroinflammatory responses and functional outcome were examined in the presence of a pote... |
Flexible interaction model for complex interactions of multiple anesthetics | BACKGROUND: Minto et al. (Anesthesiology 2000) described a mathematical approach based on response surface methods for characterizing drug-drug interactions between several intravenous anesthetic drugs. To extend this effort, the authors developed a flexible interaction model based on the general Hill dose-response rel... |
Evaluation of MP4OX for prevention of perioperative hypotension in patients undergoing primary hip arthroplasty with spinal anesthesia: A randomized, double-blind, multicenter study | Background: MP4OX (oxygenated polyethylene glycol-modified hemoglobin) is an oxygen therapeutic agent with potential applications in clinical settings where targeted delivery of oxygen to ischemic tissues is required. The primary goal of this study was to investigate MP4OX for preventing hypotensive episodes. An additi... |
Identical de novo mutation in the type 1 ryanodine receptor gene associated with fatal, stress-induced malignant hyperthermia in two unrelated families | Background: Mutations in the type 1 ryanodine receptor gene (RYR1) result in malignant hyperthermia, a pharmacogenetic disorder typically triggered by administration of anesthetics. However, cases of sudden death during exertion, heat challenge, and febrile illness in the absence of triggering drugs have been reported.... |
Desflurane Anesthesia Alters Cortical Layer-specific Hierarchical Interactions in Rat Cerebral Cortex | Background: Neurocognitive investigations suggest that conscious sensory perception depends on recurrent neuronal interactions among sensory, parietal, and frontal cortical regions, which are suppressed by general anesthetics. The purpose of this work was to investigate if local interactions in sensory cortex are also ... |
A 18F-fluorodeoxyglucose MicroPET imaging study to assess changes in brain glucose metabolism in a rat model of surgery-induced latent pain sensitization | Background: Neuroplastic changes involved in latent pain sensitization after surgery are poorly defined. We assessed temporal changes in glucose brain metabolism in a postoperative rat model using positron emission tomography. We also investigated brain metabolism after naloxone administration. Methods: Rats were given... |
The glottic aperture seal airway: A new ventilatory device | Background: None of the presently used airway devices are ideal regarding ease of insertion, alignment with the laryngeal inlet, and provision of a high-pressure seal from the environment. The purpose of this study was to determine, in awake volunteers, the performance of a new ventilatory device, the glottic aperture ... |
Invasive and concomitant noninvasive intraoperative blood pressure monitoring: Observed differences in measurements and associated therapeutic interventions | Background: Noninvasive (NIBP) and intraarterial (ABP) blood pressure monitoring are used under different circumstances and may yield different values. The authors endeavored to characterize these differences and hypothesized that there could be differences in interventions associated with the use of ABP alone ([ABP]) ... |
α2-Adrenergic receptors in human dorsal root ganglia: Predominance of α(2b) and α(2c) subtype mRNAs | Background: Nonselective α2-adrenergic receptor (α2AR) agonists (e.g., clonidine) mediate antinociception in part through α2ARs in spinal cord dorsal horn; however, use of these agents for analgesia in humans is limited by unwanted sedation and hypotension. The authors previously demonstrated α(2a) ≃ α(2b) > > &g... |
Liability associated with obstetric anesthesia: A closed claims analysis | BACKGROUND: Obstetrics carries high medical liability risk. Maternal death and newborn death/brain damage were the most common complications in obstetric anesthesia malpractice claims before 1990. As the liability profile may have changed over the past two decades, the authors reviewed recent obstetric claims in the Am... |
Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes | Background: Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-base... |
Prevalence of latex allergy among anesthesiologists: Identification of sensitized but asymptomatic individuals | Background: Occupational exposure to natural rubber latex has led to sensitization of health-care workers. However, the prevalence of latex allergy among occupationally exposed workers in American hospitals has not been reproducibly determined. The objectives of the current study were to determine the prevalence of and... |
The psychological and physiological effects of acute occupational stress in new anesthesiology residents: A pilot trial | Background: Occupational stress in resident physicians has profound implications for wellness, professionalism, and patient care. This observational pilot trial measured psychological and physiological stress biomarkers before, during, and after the start of anesthesia residency.Methods: Eighteen physician interns sche... |
Offset analgesia in neuropathic pain patients and effect of treatment with morphine and ketamine | Background: Offset analgesia, in which a disproportionally large amount of analgesia becomes apparent upon a slight decrease in noxious heat stimulation, has not been described previously in patients with chronic pain. Methods: Offset analgesia responses in 10 patients with neuropathic pain (in both legs) were compared... |
Prolonged Operative Time to Extubation Is Not a Useful Metric for Comparing the Performance of Individual Anesthesia Providers | Background: One anesthesiologist performance metric is the incidence of "prolonged" (15 min or longer after dressing complete) times to extubation. The authors used several methods to identify the performance outliers and assess whether targeting these outliers for reduction could improve operating room workflow. Metho... |
Introduction of anesthesia resident trainees to the operating room does not lead to changes in anesthesia-controlled times for efficiency measures | Background: Operating room efficiency is an important concern in most hospitals today. Little work has been reported to evaluate the contribution of anesthesia residents to changes in anesthesia-controlled time-related efficiencies in the operating room. The goal of this study was to measure the impact of the initiatio... |
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