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Effects of naloxone on opioid-induced hyperalgesia and tolerance to remifentanil under sevoflurane anesthesia in rats | Background: Opioid antagonists at ultra-low doses have been used with opioid agonists to prevent or limit opioid tolerance. The aim of this study was to evaluate whether an ultra-low dose of naloxone combined with remifentanil could block opioid-induced hyperalgesia and tolerance under sevoflurane anesthesia in rats. M... |
Remifentanil preconditioning reduces hepatic ischemia-reperfusion injury in rats via inducible nitric oxide synthase expression | Background: Opioid preconditioning against ischemia reperfusion injury has been well studied in myocardial and neuronal tissues. The objective of this study was to determine whether remifentanil could attenuate hepatic injury and to investigate the mechanisms. Methods: A rat model of hepatic ischemia reperfusion injury... |
5-hydroxytryptamine type 3 receptor modulates opioid-induced hyperalgesia and tolerance in mice | Background: Opioid-induced hyperalgesia (OIH) and tolerance are challenging maladaptations associated with opioids in managing pain. Recent genetic studies and the existing literature suggest the 5-hydroxytryptamine type 3 (5-HT3) receptor participates in these phenomena. The location of the relevant receptor populatio... |
Countering Opioid-induced Respiratory Depression in Male Rats with Nicotinic Acetylcholine Receptor Partial Agonists Varenicline and ABT 594 | Background: Opioids can induce significant respiratory depression when administered as analgesics for the treatment of acute, postoperative, and chronic pain. There are currently no pharmacologic means of reversing opioid-induced respiratory depression without interfering with analgesia. Further, there is a growing epi... |
Local anesthetic-like inhibition of voltage-gated Na + channels by the partial μ-opioid receptor agonist buprenorphine | Background: Opioids induce analgesia mainly by inhibiting synaptic transmission via G protein-coupled opioid receptors. In addition to analgesia, buprenorphine induces a pronounced antihyperalgesia and is an effective adjuvant to local anesthetics. These properties only partially apply to other opioids, and thus target... |
Consent for anesthesia clinical trials on the day of surgery: Patient attitudes and perceptions | Background: Opportunities for anesthesia research investigators to obtain consent for clinical trials are often restricted to the day of surgery, which may limit the ability of subjects to freely decide about research participation. The aim of this study was to determine whether subjects providing same-day informed con... |
Consistency, inter-rater reliability, and validity of 441 consecutive mock oral examinations in anesthesiology: Implications for use as a tool for assessment of residents | Background: Oral practice examinations (OPEs) are used extensively in many anesthesiology programs for various reasons, including assessment of clinical judgment. Yet oral examinations have been criticized for their subjectivity. The authors studied the reliability, consistency, and validity of their OPE program to det... |
Short-term, mild hypothermia can increase the beneficial effect of permissive hypotension on uncontrolled hemorrhagic shock in rats | Background: Our previous and other studies have shown that hypotensive or hypothermic resuscitation have beneficial effects on uncontrolled hemorrhagic shock. Whether hypothermia can increase the beneficial effect of hypotensive resuscitation on hemorrhagic shock is not known. Methods: Two-hundred and twenty Sprague-Da... |
Dantrolene Ameliorates Impaired Neurogenesis and Synaptogenesis in Induced Pluripotent Stem Cell Lines Derived from Patients with Alzheimer's Disease | Background: Overactivation of ryanodine receptors and the resulting impaired calcium homeostasis contribute to Alzheimer's disease-related pathophysiology. This study hypothesized that exposing neuronal progenitors derived from induced pluripotent stems cells of patients with Alzheimer's disease to dantrolene will incr... |
Part task and variable priority training in first-year anesthesia resident education: A combined didactic and simulation-based approach to improve management of adverse airway and respiratory events | BACKGROUND: Part task training (PTT) focuses on dividing complex tasks into components followed by intensive concentrated training on individual components. Variable priority training (VPT) focuses on optimal distribution of attention when performing multiple tasks simultaneously with the goal of flexible allocation of... |
Do they understand? (Part II): Assent of children participating in clinical anesthesia and surgery research | Background: Participation of children in clinical research requires not only parental permission but also the assent of the child. Although there is no fixed age at which assent should be sought, investigators should obtain assent from children considered able to provide it. This study was designed to determine childre... |
Appropriateness of Language Used in Patient Educational Materials from 24 National Anesthesiology Associations | Background: Patient education materials produced by national anesthesiology associations could be used to facilitate patient informed consent and promote the discipline of anesthesiology. To achieve these goals, materials must use language that most adults can understand. Health organizations recommend that materials b... |
Evaluation of patient simulator performance as an adjunct to the oral examination for senior anesthesia residents | Background: Patient simulators possess features for performance assessment. However, the concurrent validity and the "added value" of simulator-based examinations over traditional examinations have not been adequately addressed. The current study compared a simulator-based examination with an oral examination for asses... |
Assessing and Comparing Anesthesiologists' Performance on Mandated Metrics Using a Bayesian Approach | Background: Periodic assessment of performance by anesthesiologists is required by The Joint Commission Ongoing Professional Performance Evaluation program. Methods: The metrics used in this study were the (1) measurement of blood pressure and (2) oxygen saturation (Spo2) either before or less than 5 min after anesthes... |
Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Longterm Renal Dysfunction A Retrospective Cohort Study | Background: Perioperative acute kidney injury is common. However, it is unclear whether this merely represents a transient increase in creatinine or has prognostic value. Therefore, the long-term clinical importance of mild postoperative acute kidney injury remains unclear. This study assessed whether adults who do and... |
An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas | Background: Perioperative controlled substance diversion and tracking have received increased regulatory focus throughout the United States. The authors' institution developed and implemented an automated web-based software application for perioperative controlled substance management. The authors hypothesized that imp... |
Perioperative nerve injury after total knee arthroplasty: Regional anesthesia risk during a 20-year cohort study | Background: Perioperative nerve injury (PNI) is one of the most debilitating complications after total knee arthroplasty (TKA). Although regional anesthesia (RA) techniques reduce pain and improve functional outcomes after TKA, they may also contribute to PNI. The objective of this study was to test the hypothesis that... |
Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis | Background: Perioperative pulmonary aspiration of gastric contents has been associated with severe morbidity and death. The primary aim of this study was to identify outcomes and patient and process of care risk factors associated with gastric aspiration claims in the Anesthesia Closed Claims Project. The secondary aim... |
Modulation of tight junction proteins in the perineurium to facilitate peripheral opioid analgesia | Background: Peripheral application of opioids reduces inflammatory pain but is less effective in noninflamed tissue of rats and human patients. Hypertonic solutions can facilitate the antinociceptive activity of hydrophilic opioids in noninflamed tissue in vivo. However, the underlying mechanisms are not well understoo... |
Artifact processing methods influence on intraoperative hypotension quantification and outcome effect estimates | Background: Physiologic data that is automatically collected during anesthesia is widely used for medical record keeping and clinical research. These data contain artifacts, which are not relevant in clinical care, but may influence research results. The aim of this study was to explore the effect of different methods ... |
Spontaneous breathing during general anesthesia prevents the ventral redistribution of ventilation as detected by electrical impedance tomography: A randomized trial | Background: Positive-pressure ventilation causes a ventral redistribution of ventilation. Spontaneous breathing during general anesthesia with a laryngeal mask airway could prevent this redistribution of ventilation. We hypothesize that, compared with pressure-controlled ventilation, spontaneous breathing and pressure ... |
Surgery results in exaggerated and persistent cognitive decline in a rat model of the metabolic syndrome | Background: Postoperative cognitive decline can be reproduced in animal models. In a well-validated rat model of the Metabolic Syndrome, we sought to investigate whether surgery induced a more severe and persistent form of cognitive decline similar to that noted in preliminary clinical studies. Methods: In rats that ha... |
Global health implications of preanesthesia medical examination for ophthalmic surgery | Background: Preanesthesia medical examination is a common procedure performed before ophthalmic surgery. The frequency and characteristics of new medical issues and unstable medical conditions revealed by ophthalmic preanesthesia medical examination are unknown. We conducted a prospective observational study to estimat... |
Interactions between nitrous oxide and tissue plasminogen activator in a rat model of thromboembolic stroke | Background: Preclinical evidence in rodents has suggested that inert gases, such as xenon or nitrous oxide, may be promising neuroprotective agents for treating acute ischemic stroke. This has led to many thinking that clinical trials could be initiated in the near future. However, a recent study has shown that xenon i... |
Spectral and Entropic Features Are Altered by Age in the Electroencephalogram in Patients under Sevoflurane Anesthesia | Background: Preexisting factors such as age and cognitive performance can influence the electroencephalogram (EEG) during general anesthesia. Specifically, spectral EEG power is lower in elderly, compared to younger, subjects. Here, the authors investigate age-related changes in EEG architecture in patients undergoing ... |
A Human factors engineering study of the medication delivery process during an anesthetic self-filled syringes versus prefilled syringes | Background: Prefilled syringes (PFS) have been recommended by the Anesthesia Patient Safety Foundation. However, aspects in PFS systems compared with self-filled syringes (SFS) systems have never been explored. The aim of this study is to compare system vulnerabilities (SVs) in the two systems and understand the impact... |
Preparation of the siemens KION anesthetic machine for patients susceptible to malignant hyperthermia | Background: Preparation of anesthetic machines for use with malignant hyperthermia-susceptible (MHS) patients requires that the machines be flushed with clean fresh gas. We investigated the washout of inhalational anesthetics from the KION anesthetic machine. Methods: In part 1, halothane was circulated through KION an... |
Production pressure in the work environment: California anesthesiologists' attitudes and experiences | Background: Pressure to put efficiency, output, or continued production ahead of safety has caused catastrophic accidents in various industries. The authors assessed the attitudes and experiences of anesthesiologists concerning production pressure. Methods: A random, repeated-mailing survey was conducted among 647 memb... |
Disruption of the transient receptor potential vanilloid 1 can affect survival, bacterial clearance, and cytokine gene expression during murine sepsis | Background: Previous studies suggest that the transient receptor potential vanilloid 1 (TRPV1) channel has a role in sepsis, but it is unclear whether its effect on survival and immune response is beneficial or harmful. Methods: We studied the effects of genetic (Trpv1-knockout vs. wild-type [WT] mice) and pharmacologi... |
Application of the continual reassessment method to dose-finding studies in regional anesthesia: An estimate of the ED95 dose for 0.5% bupivacaine for ultrasound-guided supraclavicular block | Background: Previously reported estimates of the ED95 doses for local anesthetics used in brachial plexus blocks vary. The authors used the continual reassessment method, already established in oncology trials, to determine the ED95 dose for 0.5% bupivacaine for the ultrasound-guided supraclavicular block. Methods: A d... |
Estimation of the bispectral index by anesthesiologists: An inverse turing test | Background: Processed electroencephalographic indices, such as the bispectral index (BIS), are potential adjuncts for assessing anesthetic depth. While BIS® monitors might aid anesthetic management, unprocessed or nonproprietary electroencephalographic data may be a rich source of information for clinicians. We hypothe... |
State-specific effects of sevoflurane anesthesia on sleep homeostasis: Selective recovery of slow wave but not rapid eye movement sleep | Background: Prolonged propofol administration does not result in signs of sleep deprivation, and propofol anesthesia appears to satisfy the homeostatic need for both rapid eye movement (REM) and non-REM (NREM) sleep. In the current study, the effects of sevoflurane on recovery from total sleep deprivation were investig... |
Lack of Association between Blood Pressure Management by Anesthesia Residents and Competence Committee Evaluations or In-training Exam Performance: A Cohort Analysis | Background: Prompt treatment of severe blood pressure instability requires both cognitive and technical skill. The ability to anticipate and respond to episodes of hemodynamic instability should improve with training. The authors tested the hypothesis that the duration of severe hypotension during anesthesia administer... |
Prophylactic Intrathecal Morphine and Prevention of Post-Dural Puncture Headache A Randomized Double-blind Trial | Background: Prophylactic epidural morphine administration after unintentional dural puncture with a large-bore needle has been shown to decrease the incidence of post-dural puncture headache. The authors hypothesized that prophylactic administration of intrathecal morphine would decrease the incidence of post-dural pun... |
AZD-3043: A novel, metabolically labile sedative-hypnotic agent with rapid and predictable emergence from hypnosis | Background: Propofol can be associated with delayed awakening after prolonged infusion. The aim of this study was to characterize the preclinical pharmacology of AZD-3043, a positive allosteric modulator of the γ-aminobutyric acid type A (GABAA) receptor containing a metabolically labile ester moiety. The authors postu... |
In vitro kinetic evaluation of the free radical scavenging ability of propofol | Background: Propofol is a widely used, short-acting, and intravenously administered hypnotic agent with notable antioxidant and free radical scavenging activities. However, there are relatively few kinetic studies on the free radical scavenging ability of propofol. The goal of this study is to evaluate the kinetics of ... |
Comparison of Neonatal and Adult Fibrin Clot Properties between Porcine and Human Plasma | Background: Recent studies suggest that adult-specific treatment options for fibrinogen replacement during bleeding may be less effective in neonates. This is likely due to structural and functional differences found in the fibrin network between adults and neonates. In this investigation, the authors performed a compa... |
Neuroprotective effect of orexin-A is mediated by an increase of hypoxia-inducible factor-1 activity in rat | Background: Recent studies suggest that the novel neuropeptide orexin-A may play an essential role during neuronal damage. However, the function of orexin-A during brain ischemia remains unclear. Recently, hypoxia-inducible factor-1α (HIF-1α) was shown to be activated by orexin-A. The aim of the current study is to tes... |
Combination of EuroSCORE and cardiac troponin i improves the prediction of adverse outcome after cardiac surgery | Background: Reclassification tables have never been used to compare concentrations of cardiac troponin I (cTnI) with predictive models of risk in the perioperative setting. The current study aimed to evaluate the prognostic value of pre- and/or postoperative serum cTnI when combined with The European System for Cardiac... |
The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers | Background: Remifentanil (GI87084B) is a new short-acting opioid with a unique ester structure. Metabolism of remifentanil by ester hydrolysis results in very rapid elimination. The aim of this study was to characterize in detail the pharmacokinetic profile of remifentanil in healthy male volunteers. Methods: Ten healt... |
Isoflurane activates intestinal sphingosine kinase to protect against renal ischemia-reperfusion-induced liver and intestine injury | Background: Renal ischemia-reperfusion injury (IRI) is a major cause of acute kidney injury and often leads to multiorgan dysfunction and systemic inflammation. Volatile anesthetics have potent antiinflammatory effects. We aimed to determine whether the representative volatile anesthetic isoflurane protects against acu... |
Anesthesiology Resident Night Float Duty Alters Sleep Patterns: An Observational Study | BACKGROUND: Residency programs utilize night float systems to adhere to duty hour restrictions; however, the influence of night float on resident sleep has not been described. The study aim was to determine the influence of night float on resident sleep patterns and quality of sleep. We hypothesized that total sleep ti... |
Driving performance of residents after six consecutive overnight work shifts | Background: Residency training requires work in clinical settings for extended periods of time, resulting in altered sleep patterns, sleep deprivation, and potentially deleterious effects on safe performance of daily activities, including driving a motor vehicle. Methods: Twenty-nine anesthesiology resident physicians ... |
Inappropriate Citation of Retracted Articles in Anesthesiology and Intensive Care Medicine Publications | Background: Retracted articles represent research withdrawn from the existing body of literature after publication. Research articles may be retracted for several reasons ranging from honest errors to intentional misconduct. They should not be used as reliable sources, and it is unclear why they are cited occasionally ... |
Salvinorin a produces cerebrovasodilation through activation of nitric oxide synthase, κ receptor, and adenosine triphosphate-sensitive potassium channel | Background: Salvinorin A is a nonopioid, selective κ opioid-receptor agonist. Despite its high potential for clinical application, its pharmacologic profile is not well known. In the current study, we hypothesized that salvinorin A dilates pial arteries via activation of nitric oxide synthase, adenosine triphosphate-se... |
Cysteinyl leukotrienes impair hypoxic pulmonary vasoconstriction in endotoxemic mice | Background: Sepsis impairs hypoxic pulmonary vasoconstriction (HPV) in patients and animal models, contributing to systemic hypoxemia. Concentrations of cysteinyl leukotrienes are increased in the bronchoalveolar lavage fluid of patients with sepsis, but the contribution of cysteinyl leukotrienes to the impairment of H... |
Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: A prospective, randomized, clinical trial | Background: Severe preamputation pain is associated with phantom limb pain (PLP) development in limb amputees. We investigated whether optimized perioperative analgesia reduces PLP at 6-month follow-up. Methods: A total of 65 patients underwent lower-limb amputation and were assigned to five analgesic regimens: (1) Epi... |
Simulation-based training improves physicians performance in patient care in high-stakes clinical setting of cardiac surgery | Background: Simulation-based training is useful in improving physicians skills. However, no randomized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care. This study aimed to determine whether simulation-based training or an interactive seminar resulted in bette... |
Disrupted sleep and delayed recovery from chronic peripheral neuropathy are distinct phenotypes in a rat model of metabolic syndrome | Background: Sleep apnea, hypertension, atherosclerosis, and obesity are features of metabolic syndrome associated with decreased restorative sleep and increased pain. These traits are relevant for anesthesiology because they confer increased risks of a negative anesthetic outcome. This study tested the one-tailed hypot... |
Gender differences in anesthesiologists' annual incomes | BACKGROUND: Specialty, work effort, and gender have been shown to be associated with physicians' annual incomes; however, careful examination of the association between provider gender and annual income after correcting for other factors likely to influence income has not been conducted for anesthesiologists. METHODS: ... |
Reversal of the sedative and sympatholytic effects of dexmedetomidine with a specific α2-adrenoceptor antagonist atipamezole. A pharmacodynamic and kinetic study in healthy volunteers | Background: Specific and selective α2-adrenergic drugs are widely exploited in veterinary anesthesiology. Because α2-agonists are also being introduced to human practice, the authors studied reversal of a clinically relevant dexmedetomidine dose with atipamezole, an α2-antagonist, in healthy persons. Methods: The study... |
Effect of inhibition of spinal cord glutamate transporters on inflammatory pain induced by formalin and complete freund's adjuvant | Background: Spinal cord glutamate transporters clear synaptically released glutamate and maintain normal sensory transmission. However, their ultrastructural localization is unknown. Moreover, whether and how they participate in inflammatory pain has not been carefully studied. Methods: Immunogold labeling with electro... |
Simulator training enhances resident performance in transesophageal echocardiography | Background: Standardized training via simulation as an educational adjunct may lead to a more rapid and complete skill achievement. The authors hypothesized that simulation training will also enhance performance in transesophageal echocardiography image acquisition among anesthesia residents. © 2013, the American Socie... |
Positioning in anesthesiology | Background: Stretch-induced neuropathy of the brachial plexus and median nerve in conventional perioperative care remains a relatively frequent and poorly understood complication. Guidelines for positioning have been formulated, although the protective effect of most recommendations remains unexamined. The similarity b... |
Autologous transplantation of peripheral blood-derived circulating endothelial progenitor cells attenuates endotoxin-induced acute lung injury in rabbits by direct endothelial repair and indirect immunomodulation | Background: Studies have demonstrated the role of circulating endothelial progenitor cells (EPCs) in maintaining normal endothelial function and in endothelial repairing. This study was aimed to observe the protective effects of autologous transplantation of circulating EPCs against endotoxin-induced acute lung injury ... |
Substance use disorder in physicians after completion of training in anesthesiology in the United States from 1977 to 2013 | Background: Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence a... |
Blind intubation through self-pressurized, disposable supraglottic airway laryngeal intubation masks: An international, multicenter, prospective cohort study | Background: Supraglottic airway devices commonly are used for securing the airway during general anesthesia. Occasionally, intubation with an endotracheal tube through a supraglottic airway is indicated. Reported success rates for blind intubation range from 15 to 97%. The authors thus investigated as their primary out... |
Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: Systematic review and meta-analysis of randomized controlled trials | Background: Systemic α2 agonists are believed to reduce pain and opioid requirements after surgery, thus decreasing the incidence of opioid-related adverse effects, including hyperalgesia. Methods: The authors searched for randomized placebo-controlled trials testing systemic α2 agonists administrated in surgical patie... |
Assessment of the intrarater and interrater reliability of an established clinical task analysis methodology | Background: Task analysis may be useful for assessing how anesthesiologists alter their behavior in response to different clinical situations. In this study, the authors examined the intraobserver and interobserver reliability of an established task analysis methodology. Methods: During 20 routine anesthetic procedures... |
Effectiveness of written and oral specialty certifcation examinations to predict actions against the medical licenses of anesthesiologists | Background: Te American Board of Anesthesiology administers written and oral examinations for its primary certifcation. Tis retrospective cohort study tested the hypothesis that the risk of a disciplinary action against a physician's medical license is lower in those who pass both examinations than those who pass only ... |
Assessment of clinical performance during simulated crises using both technical and behavioral ratings | Background: Techniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by multiple independ... |
Study of the "sniffing position" by magnetic resonance imaging | Background: The "sniffing position" is widely considered essential to the performance of orotracheal intubation and has become the cornerstone of training in anesthesiology. However, the anatomic superiority of this patient head position has not been established. Methods: Eight healthy young adult volunteers underwent ... |
Spinal anesthesia: Functional balance is impaired after clinical recovery | Background: The ability of patients to walk without assistance after spinal anesthesia is a determining factor in the time to discharge following ambulatory surgery. The authors compared clinical markers of gross motor recovery with objective data of functional balance after spinal anesthesia. Methods: Twenty-two male ... |
Measurement of individual clinical productivity in an academic anesthesiology department | Background: The ability to measure productivity, work performed, or contributions toward the clinical mission has become an important issue facing anesthesiology departments in private practice and academic settings. Unfortunately, the practice and billing of anesthesia services makes it difficult to quantify individua... |
Thoracic epidural anesthesia for cardiac surgery: A randomized trial | Background: The addition of thoracic epidural anesthesia (TEA) to general anesthesia (GA) during cardiac surgery may have a beneficial effect on clinical outcomes. TEA in cardiac surgery, however, is controversial because the insertion of an epidural catheter in patients requiring full heparinization for cardiopulmonar... |
Treatment with carbon monoxide-releasing molecules and an HO-1 inducer enhances the effects and expression of μ-opioid receptors during neuropathic pain | Background: The administration of μ-opioid receptors (MOR) and δ-opioid receptors (DOR) as well as cannabinoid-2 receptor (CB2R) agonists attenuates neuropathic pain. We investigated if treatment with two carbon monoxide-releasing molecules (CORM-2 and CORM-3) or an inducible heme oxygenase inducer (cobalt protoporphyr... |
Patient-controlled regional analgesia (PCRA) at home: Controlled comparison between bupivacaine and ropivacaine brachial plexus analgesia | Background: The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital. Me... |
Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery: A prospective, randomized, controlled trial | Background: The aim of this two-center, open, randomized, controlled trial was to evaluate the impact of thoracic epidural anesthesia on early clinical outcomes in patients undergoing off-pump coronary artery bypass surgery. Methods: Two hundred and twenty-six patients were randomized to either general anesthesia plus ... |
Effect of the BASIC Examination on Knowledge Acquisition during Anesthesiology Residency | Background: The American Board of Anesthesiology recently introduced the BASIC Examination, a component of its new staged examinations for primary certification, typically offered to residents at the end of their first year of clinical anesthesiology training. This analysis tested the hypothesis that the introduction o... |
A Smartphone-based decision support tool improves test performance concerning application of the guidelines for managing regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy | Background: The American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus statement on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy is the standard for evaluation and management of these patients. The authors hypothesized that an electronic decision support tool (... |
Protective and detrimental effects of sodium sulfide and hydrogen sulfide in murine ventilator-induced lung injury | Background: The antiinflammatory effects of hydrogen sulfide (H 2S) and sodium sulfide (Na2S) treatment may prevent acute lung injury induced by high tidal volume (HVT) ventilation. However, lung protection may be limited by direct pulmonary toxicity associated with H 2S inhalation. Therefore, the authors tested whethe... |
Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation | Background: The assessment of diaphragm function with diaphragm ultrasound seems to bring important clinical information to describe diaphragm work and weakness. When the diaphragm is weak, extradiaphragmatic muscles may play an important role, but whether ultrasound can also assess their activity and function is unkno... |
Motivation and maternal presence during induction of anesthesia | Background: The authors developed a measure to determine whether maternal motivation to be present during induction (Motivation for Parental Presence during Induction of Anesthesia [MPPIA]) is related to children's anxiety during the induction process. Methods: Mothers and children (aged 2-12 yr) undergoing outpatient,... |
Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery | Background: The authors investigated the effect of a single preoperative bolus of erythropoietin on perioperative transfusion requirement and erythropoiesis in patients with preoperative anemia undergoing valvular heart surgery. Methods: In this prospective, single-site, single-blinded, randomized, and parallel-arm con... |
Trends in quality of anesthesia care associated with changing staffing patterns, productivity, and concurrency of case supervision in a teaching hospital | Background: The authors used continuous quality improvement (CQI) program data to investigate trends in quality of anesthesia care associated with changing staffing patterns in a university hospital. Methods: The monthly proportion of cases performed by solo attending anesthesiologists versus attending-resident teams o... |
Trends in anesthesia-related death and brain damage: A closed claims analysis | BACKGROUND: The authors used the American Society of Anesthesiologists Closed Claims Project database to determine changes in the proportion of claims for death or permanent brain damage over a 26-yr period and to identify factors associated with the observed changes. METHODS: The Closed Claims Project is a structured ... |
The validity of performance assessments using simulation | Background: The authors wished to determine whether a simulator-based evaluation technique assessing clinical performance could demonstrate construct validity and determine the subjects' perception of realism of the evaluation process. Methods: Research ethics board approval and informed consent were obtained. Subjects... |
Simulation technology: A comparison of experiential and visual learning for undergraduate medical students | Background: The availability of simulator technology at the University of Toronto (Toronto, Ontario, Canada) provided the opportunity to compare the efficacy of video-assisted and simulator-assisted learning. Methods: After ethics approval from the University of Toronto, all final-year medical students were invited to ... |
Teaching with a video system improves the training period but not subsequent success of tracheal intubation with the Bullard laryngoscope | Background: The Bullard laryngoscope is useful for the management of a variety of airway management scenarios. Without the aid of a video system, teaching laryngoscopy skills occurs with indirect feedback to the instructor. The purpose of this study was to determine if use of a video system would quicken the process of... |
Postoperative modulation of central nervous system prostaglandin E2 by cyclooxygenase inhibitors after vascular surgery (Retraction in: Anesthesiology (2009) 110:3 (689)) | Background: The clinical availability of injectable cyclooxygenase inhibitors allows examination of the importance of cyclooxygenase 1 and 2 after surgery. The authors hypothesize that spinal prostaglandin E2 increases with lower extremity vascular surgery and that spinal prostaglandin E2 decreases with intravenous pos... |
Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization- activated cation current | Background: The current study was designed to test the hypothesis that the increased duration of analgesia caused by adding dexmedetomidine to local anesthetic results from blockade of the hyperpolarization-activated cation (Ih) current. Methods: In this randomized, blinded, controlled study, the analgesic effects of p... |
Accuracy of pharmacokinetic models for predicting plasma fentanyl concentrations in lean and obese surgical patients: Derivation of dosing weight ("pharmacokinetic mass") | Background: The currently available pharmacokinetic models for fentanyl were derived from normal weight patients and were not scaled to body weight. Their application to obese patients may cause overprediction of the plasma concentration of fentanyl. This study examined the influence of body weight on the predictive ac... |
Value of debriefing during simulated crisis management: Oral versus video-assisted oral feedback | BACKGROUND: The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process ... |
Development of an objective scoring system for measurement of resident performance on the human patient simulator | BACKGROUND: The decrease in the percentage of patients having cesarean delivery during general anesthesia has led some educators to advocate the increased use of simulation-based training for this anesthetic. The authors developed a scoring system to measure resident performance of this anesthetic on the human patient ... |
Effect of simulation training on compliance with difficult airway management algorithms, technical ability, and skills retention for emergency cricothyrotomy | Background: The effectiveness of simulation is rarely evaluated. The aim of this study was to assess the impact of a short training course on the ability of anesthesiology residents to comply with current difficult airway management guidelines. Methods: Twenty-seven third-year anesthesiology residents were assessed on ... |
Scholarly productivity and National Institutes of Health funding of Foundation for Anesthesia Education and Research grant recipients: Insights from a bibliometric analysis | Background: The Foundation for Anesthesia Education and Research (FAER) grant program provides fellows and junior faculty members with grant support to stimulate their careers. The authors conducted a bibliometric analysis of recipients of FAER grants since 1987. Methods: Recipients were identified in the FAER alumni d... |
Evaluation of the foundation for anesthesia education and research medical student anesthesia research fellowship program participants' scholarly activity and career choices | Background: The Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship (MSARF) program is an 8-week program that pairs medical students with anesthesiologists performing anesthesia-related research. This study evaluated the proportion of students who published an article from th... |
Lipid emulsion reverses levobupivacaine-induced responses in isolated rat aortic vessels | Background: The goal of this in vitro study was to investigate the effects of lipid emulsion (LE) on local anesthetic levobupivacaine-induced responses in isolated rat aorta and to determine whether the effect of LE is related to the lipid solubility of local anesthetics. Methods: Isolated rat aortic rings were suspend... |
Risk and outcomes of substance use disorder among anesthesiology residents: A matched cohort analysis | Background: The goal of this work is to evaluate selected risk factors and outcomes for substance use disorder (SUD) in physicians enrolled in anesthesiology residencies approved by the Accreditation Council for Graduate Medical Education. Methods: For each of 384 individuals with evidence of SUD while in primary resid... |
The effect of anesthetic technique on postoperative outcomes in hip fracture repair | Background: The impact of anesthetic choice on postoperative mortality and morbidity has not been determined with certainty. Methods: The authors evaluated the effect of type of anesthesia on postoperative mortality and morbidity in a retrospective cohort study of consecutive hip fracture patients, aged 60 yr or older,... |
Perioperative comparative effectiveness of anesthetic technique in orthopedic patients | Background: The impact of anesthetic technique on perioperative outcomes remains controversial. We studied a large national sample of primary joint arthroplasty recipients and hypothesized that neuraxial anesthesia favorably influences perioperative outcomes. Methods: Data from approximately 400 hospitals between 2006 ... |
Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery | Background: The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less ... |
Reducing the incidence of substance use disorders in anesthesiology residents 13 years of comprehensive urine drug screening | Background: The incidence of substance use disorders in the United States among residents in anesthesiology is between 1% and 2%. A recent study reported that the incidence of substance use disorders in U.S. anesthesiology residents has been increasing. There are no reports of effective methods to prevent substance use... |
Ventilatory protective strategies during thoracic surgery: Effects of alveolar recruitment maneuver and low-tidal volume ventilation on lung density distribution | Background: The increased tidal volume (VT) applied to the ventilated lung during one-lung ventilation (OLV) enhances cyclic alveolar recruitment and mechanical stress. It is unknown whether alveolar recruitment maneuvers (ARMs) and reduced VT may influence tidal recruitment and lung density. Therefore, the effects of ... |
Exhaled breath condensate in mechanically ventilated brain-injured patients with no lung injury or sepsis | Background: The inflammatory influence of prolonged mechanical ventilation in uninjured lungs remains a matter of controversy and largely unexplored in humans. The authors investigated pulmonary inflammation by using exhaled breath condensate (EBC) in mechanically ventilated, brain-injured patients in the absence of ac... |
Polymorphism in the interleukin-1 receptor antagonist gene is associated with serum interleukin-1 receptor antagonist concentrations and postoperative opioid consumption | Background: The interleukin-1 receptor antagonist (IL-1Ra) is the principal determinant of IL-1β bioactivity within the IL-1 gene cluster, regulating IL-1α and IL-1β release. This study was designed to determine whether polymorphisms of the IL-1Ra gene (IL1RN) produce clinically measurable differences in serum IL-1Ra c... |
Teamwork in the operating room: Frontline perspectives among hospitals and operating room personnel | BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist. METHODS: OR personnel in 60 US hospitals were surveyed using the... |
Current Transfusion Practices of Members of the American Society of Anesthesiologists: A Survey | Background: The last published survey of transfusion practices among members of the American Society of Anesthesiologists (ASA) was conducted in 1981. The ASA Committee on Transfusion Medicine conducted a new transfusion survey in 2002. Methods: The survey was mailed to 2,500 randomly selected active ASA members. The p... |
Efficacy, safety, and pharmacokinetics of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in elderly patients | Background: The management of elderly patients can be challenging for anesthesiologists for many reasons, including altered pharmacokinetics and dynamics. This study compared the efficacy, safety, and pharmacokinetics of sugammadex for moderate rocuronium-induced neuromuscular blockade reversal in adult (aged 18-64 yr)... |
Lidocaine blocks the hyperpolarization-activated mixed cation current, ih, in rat thalamocortical neurons | Background: The mechanisms that underlie the supraspinal central nervous system effects of systemic lidocaine are poorly understood and not solely explained by Na+ channel blockade. Among other potential targets is the hyperpolarization-activated cation current, Ih, which is blocked by lidocaine in peripheral neurons. ... |
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