Carlo Pancaro, Jasmine Purtell, Dana LaBuda, Leif Saager, Thomas T Klumpner, Timur Dubovoy, Baskar Rajala, Shubhangi Singh, Ruth Cassidy, Christie Vahabzadeh, Sean Maxwell, Virgil Manica, David M Eckmann, Jill M Mhyre, Milo C Engoren
BACKGROUND: While flexible epidural catheters reduce the risk of paresthesia and intravascular cannulation, they may be more challenging to advance beyond the tip of a Tuohy needle. This may increase placement time, number of attempts, and possibly complications when establishing labor analgesia. This study investigated the ability to advance flexible epidural catheters through different epidural needles from 2 commonly used, commercially available, epidural kits. METHODS: We hypothesized that the multiorifice wire-reinforced polyamide nylon blend epidural catheters will have a higher rate of successful first attempt insertion than the single-end hole wire-reinforced polyurethane catheters for the establishment of labor analgesia...
April 9, 2021: Anesthesia and Analgesia
Daniel Katz, Brian T Bateman, Klaus Kjaer, Dana P Turner, Nicole Z Spence, Ashraf S Habib, Ronald B George, Roulhac D Toledano, Gilbert Grant, Hannah E Madden, Alex J Butwick, Grant Lynde, Rebecca D Minehart, Yaakov Beilin, Timothy T Houle, Emily E Sharpe, Bhavani Kodali, Shobana Bharadwaj, Michaela K Farber, Arvind Palanisamy, Malavika Prabhu, Nikolai Y Gonzales, Ruth Landau, Lisa Leffert
BACKGROUND: Early reports associating SARS-CoV-2 infection with adverse pregnancy outcomes were biased by including only women with severe disease without controls. The Society for Obstetric Anesthesia and Perinatology (SOAP) COVID Registry was created to compare peripartum outcomes and anesthetic utilization in women with and without SARS-CoV-2 infection delivering at institutions with widespread testing. METHODS: Deliveries from 14 U.S. medical centers, March 19-May 31, 2020, were included...
April 8, 2021: Anesthesia and Analgesia
Kyan C Safavi, Hao Deng, William Driscoll, Milcho Nikolov, Kalpan Tolia, Jeanine P Wiener-Kronish
BACKGROUND: The traditional paradigm of hospital surgical ward care consists of episodic bedside visits by providers with periodic perusals of the patient's electronic health record (EHR). Vital signs and laboratory results are directly pushed to the EHR but not to providers themselves. Results that require intervention may not be recognized for hours. Remote surveillance programs continuously monitor electronic data and provide automatic alerts that can be routed to multidisciplinary providers...
April 8, 2021: Anesthesia and Analgesia
Charles-Hervé Vacheron, Julie Hentzen, Mathieu Fauvernier, Michel Fessy, Philippe Chaudier, Verena Landel, Jean Stephane David, Pascal Incagnoli, Vincent Piriou, Arnaud Friggeri
BACKGROUND: For more than 20 years, hip fracture 1-year mortality has remained around 20%. An elevation of the postoperative troponin peak within 72 hours (myocardial injury after noncardiac surgery [MINS]) is associated with a greater risk of short-term mortality in the general population. However, there seem to be conflicting results in the specific population who undergo hip fracture surgery, with some studies finding an association between troponin and mortality and some not. The objective of the present study was to investigate the association of MINS and the short- (before 28th day), intermediate- (before 180th day), and long-term (before 365th day) mortality after hip fracture surgery...
April 8, 2021: Anesthesia and Analgesia
Amanda L Stone, Dima Qu'd, Twila Luckett, Scott D Nelson, Erin E Quinn, Amy L Potts, Stephen W Patrick, Stephen Bruehl, Andrew D Franklin
BACKGROUND: Opioid analgesics are commonly prescribed for postoperative analgesia following pediatric surgery and often result in leftover opioid analgesics in the home. To reduce the volume of leftover opioids and overall community opioid burden, the State of Tennessee enacted a policy to reduce initial opioid prescribing to a 3-day supply for most acute pain incidents. We aimed to evaluate the extent of leftover opioid analgesics following pediatric ambulatory surgeries in the context of a state-mandated restrictive opioid-prescribing policy...
March 31, 2021: Anesthesia and Analgesia
Michael R Boswell, Mark M Smith, Ryan D Frank, Michael J Brown, Arnoley S Abcejo, Todd M Kor, Rajiv Gulati, Bradford B Smith
BACKGROUND: Patients with existing coronary artery stents are at an increased risk for major adverse cardiac events (MACEs) when undergoing noncardiac surgery (NCS). Although the use of antifibrinolytic (AF) therapy in NCS has significantly increased in the past decade, the relationship between perioperative AF use and its association with MACEs among patients with existing coronary artery stents has yet to be assessed. In this study, we aim to evaluate the association of MACEs in patients with existing coronary artery stents who receive perioperative AF therapy during orthopedic surgery...
March 29, 2021: Anesthesia and Analgesia
Woon H Chong, Biplab K Saha, Boris I Medarov
Arterial blood gas (ABG) analysis is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body. However, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Central venous blood gas (VBG) is a potentially more accessible alternative to ABG sampling. Current evidence suggests that pH and Pco2 obtained via peripheral VBG correlate well with ABG measurement...
March 29, 2021: Anesthesia and Analgesia
Jeffrey M Feldman, Kai Kuck, Thomas Hemmerling
No abstract text is available yet for this article.
March 29, 2021: Anesthesia and Analgesia
Deborah A Rusy, Anita Honkanen, Mary F Landrigan-Ossar, Debnath Chatterjee, Lawrence I Schwartz, Kirk Lalwani, Jennifer R Dollar, Randall Clark, Christina D Diaz, Nina Deutsch, David O Warner, Sulpicio G Soriano
Electronic cigarettes (e-cigarettes) or vaping use in adolescents has emerged as a public health crisis that impacts the perioperative care of this vulnerable population. E-cigarettes have become the most commonly used tobacco products among youth in the United States. Fruit and mint flavors and additives such as marijuana have enticed children and adolescents. E-cigarette, or vaping, product use-associated lung injury (EVALI) is a newly identified lung disease linked to vaping. Clinical presentation of EVALI can be varied, but most commonly includes the respiratory system, gastrointestinal (GI) tract, and constitutional symptoms...
March 29, 2021: Anesthesia and Analgesia
Brina Snyder, Stephanie M Simone, Tania Giovannetti, Thomas F Floyd
Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated...
March 29, 2021: Anesthesia and Analgesia
Raiko Blondonnet, Marc Begard, Matthieu Jabaudon, Thomas Godet, Benjamin Rieu, Jules Audard, Kevin Lagarde, Emmanuel Futier, Bruno Pereira, Pierre Bouzat, Jean-Michel Constantin
BACKGROUND: Chest injuries are associated with mortality among patients admitted to the intensive care unit (ICU) and require multimodal pain management strategies, including regional anesthesia (RA). We conducted a survey to determine the current practices of physicians working in ICUs regarding RA for the management of chest trauma in patients with multiple traumas. METHODS: An online questionnaire was sent to medical doctors (n = 1230) working in French ICUs, using the Société Française d'Anesthésie Réanimation (SFAR) mailing list of its members...
March 29, 2021: Anesthesia and Analgesia
Carolyn F Weiniger, Michael Heesen, David Knigin, Frederic Deutsch, Nicole Hilber, Alexander Avidan
BACKGROUND: Low-dose (≤8 mg) hyperbaric bupivacaine for spinal anesthesia during cesarean delivery results in reduced efficacy, yet as a secondary outcome was associated with reduced frequency of spinal-induced hypotension. Our primary aim was to investigate the relationship between hyperbaric bupivacaine dose and the occurrence of spinal-induced hypotension for cesarean delivery. METHODS: Retrospective study of cesarean delivery under spinal or combined spinal anesthesia with hyperbaric bupivacaine in 1 academic institution (2 centers-tertiary and district) from 2012 to 2018...
March 29, 2021: Anesthesia and Analgesia
Susan K Sankova, Seema Deshpande, Steve P Miller, Kenichi Tanaka
No abstract text is available yet for this article.
March 29, 2021: Anesthesia and Analgesia
Barry D Kussman, Syed M Imaduddin, Mohammad Hadi Gharedaghi, Thomas Heldt, Kerri LaRovere
Transcranial Doppler (TCD) ultrasonography is the only noninvasive bedside technology for the detection and monitoring of cerebral embolism. TCD may identify patients at risk of acute and chronic neurologic injury from gaseous or solid emboli. Importantly, a window of opportunity for intervention-to eliminate the source of the emboli and thereby prevent subsequent development of a clinical or subclinical stroke-may be identified using TCD. In this review, we discuss the application of TCD sonography in the perioperative and intensive care setting in adults and children known to be at increased risk of cerebral embolism...
March 25, 2021: Anesthesia and Analgesia
Aditee P Ambardekar, K Karisa Walker, Anne Marie McKenzie-Brown, Kaitlyn Brennan, Chelsia Jackson, Laura Edgar, Herodotos Ellinas, Timothy R Long, Carlos E Trombetta, Martin G Laskey, Bradley W Wargo, Rupa J Dainer, Crys S Draconi, John D Mitchell
The evolution of medical education, from a time-based to a competency-based platform, began nearly 30 years ago and continues to slowly take shape. The development of valid and reproducible assessment tools is the first step. Medical educators across specialties acknowledge the challenges and remain motivated to develop a relevant, generalizable, and measurable system. The Accreditation Council for Graduate Medical Education (ACGME) remains committed to its responsibility to the public by assuring that the process and outcome of graduate medical education in the nation's residency programs produce competent, safe, and compassionate doctors...
March 25, 2021: Anesthesia and Analgesia
Albert C Perrino, Natalie F Holt
No abstract text is available yet for this article.
March 25, 2021: Anesthesia and Analgesia
Honorio T Benzon, Timothy P Maus, Hye-Ryun Kang, David A Provenzano, Anuj Bhatia, Felix Diehn, Ariana Nelson, Zachary L McCormick, Benjamin P Liu, Javier de Andres Ares, Magdalena Anitescu, Kristine Blackham, Arun Bhaskar, Silviu Brill, Jeremy Collins, Ashish Gulve, Robert W Hurley, Young Hoon Jeon, Jee Youn Moon, Richard L Rauck, Meghan Rodes, Ryan K Lee, Vinil Shah, Harsha Shanthanna, Jan van Zundert, Marc Huntoon, James P Rathmell, Mario Sanchez Borges, Steven P Cohen, Paul A Greenberger
This Practice Advisory presents a comprehensive and evidence-based set of position statements and recommendations for the use of contrast media in interventional pain procedures. The advisory was established by an international panel of experts under the auspices of 11 multinational and multispecialty organizations based on a comprehensive review of the literature up to December 31, 2019. The advisory discusses the risks of using gadolinium-based contrast agents. These include nephrogenic systemic fibrosis, gadolinium brain deposition/retention, and encephalopathy and death after an unintentional intrathecal gadolinium injection...
March 23, 2021: Anesthesia and Analgesia
Simon J Davies, Monty Mythen
BACKGROUND: Intraoperative hypotension is a common event, and a recent study suggests that maintenance of blood pressure may reduce complications. The splanchnic circulation provides a reservoir of blood that can be mobilized during hemorrhage; hence, intestinal microcirculation is sensitive to volume changes. The aim of this study was to assess the impact of hemorrhage on intestinal microcirculation and hemodynamics, and the effects of phenylephrine on these parameters. METHODS: Eight anesthetized, mechanically ventilated Yorkshire/Landrace crossbreed pigs were studied...
March 23, 2021: Anesthesia and Analgesia
Francesco Carli, Rashami Awasthi, Chelsia Gillis, Gabriele Baldini, Amal Bessissow, Alexander Sender Liberman, Enrico Maria Minnella
No abstract text is available yet for this article.
March 16, 2021: Anesthesia and Analgesia
Dale A Parks, Roland T Short, Philip J McArdle, Amandiy Liwo, Joshua M Hagood, Sandra J Crump, Ayesha S Bryant, Thomas R Vetter, Charity J Morgan, T Mark Beasley, Keith A Jones
BACKGROUND: Postoperative pulmonary complications can have a significant impact on the morbidity and mortality of patients undergoing major surgeries. Intraoperative lung protective strategies using low tidal volume (TV) ventilation and positive end-expiratory pressure (PEEP) have been demonstrated to reduce the incidence of pulmonary injury and infection while improving oxygenation and respiratory mechanics. The purpose of this study was to develop decision support systems designed to optimize behavior of the attending anesthesiologist with regards to adherence with established intraoperative lung-protective ventilation (LPV) strategies...
March 16, 2021: Anesthesia and Analgesia
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