Story Category: Anesthesia

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THOSE who anesthetize patients with ketamine (originally given the clinical investigation number CI-581) realize it is a unique pharmacological agent. Ever since its introduction into human clinical anesthesia, ketamine has had a turbulent history. One only has to witness ketamine anesthesia emergence delirium to realize this agent produces unique psychic effects. Nevertheless, the value and safety of ketamine in the anesthetic management of a specific... Read More | Comment
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The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital.... Read More | Comment
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Medically fragile infants on ventilation support at community or rural hospitals without surgical services sometimes need those services. That poses a challenge for pediatric anesthesiologists who need to assess these babies preoperatively and discuss their anesthesia plan for surgery with their parents without transporting such vulnerable patients. For Joann Hunsberger and Sally Bitzer, anesthesiologists and critical care specialists at Johns Hopkins Children’s Center, the answer... Read More | Comment
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Patients with refractory status epilepticus (RSE) treated with continuous intravenous anesthetic drugs (cIVADs) may benefit from early initiation of such therapy. wWhen cIVADs are applied in RSE, prescribing them early may positively impact outcome, probably by shorter seizure duration and apparently mainly in those patients who do not have a severe RSE etiology dominating their prognosis. Fifty-three (68.8%) patients received cIVADs within the first 48... Read More | Comment
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This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second-generation “ketamine-like” fast-acting antidepressants. Currently available antidepressant medications act through monoaminergic systems, are ineffective for many individuals suffering from depression, and are associated with a delayed onset of peak efficacy of several months.... Read More | Comment
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Pre-preparation of Preparation on Pre-hospital Emergency (PHEA) equipment and drugs resulted in safer performance of PHEA and has the potential to reduce on-scene time by up to a third. In total 23 experiments were completed, 12 using experimental method and 11 using standard practice. Time required to perform PHEA using the experimental method was significantly shorter than with standard practice (11,45 versus 20:59) minutes: seconds;... Read More | Comment
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Statistically significant results in anesthesia and critical care randomized controlled trials are often fragile, and study conclusions are frequently affected by spin. Routine calculation of the Fragility Index in medical literature may allow for better understanding of trials and therefore enhance the quality of reporting. We identified 166 eligible randomized controlled trials with a median sample size of 207 patients (interquartile range, 109–497). The median... Read More | Comment
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Intravenous caffeine is able to accelerate emergence from isoflurane anesthesia in healthy males without any apparent adverse effects. All randomized participants were included in the analysis. The mean time to emergence with saline was 16.5 ± 3.9 (SD) min compared to 9.6 ± 5.1 (SD) min with caffeine (P = 0.002), a difference of 6.9 min (99% CI, 1.8 to 12), a 42% reduction. Participants emerged at a higher expired... Read More | Comment
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This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room. Of 3472 patients randomized, mean (SD) age was 51 (19) years and 1777 (51%) were men. The primary end point, pulmonary aspiration, occurred in 10 patients (0.6%) in... Read More | Comment
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The American Society of Anesthesiologists (ASA) difficult airway algorithm recommends that if initial attempts at tracheal intubation after the induction of general anesthesia are unsuccessful, the practitioner should “consider the advisability of awakening the patient”. With respect to the use of muscle relaxants, “awakening” is assumed to mean return to an unparalyzed state that permits life-sustaining spontaneous ventilation (hereafter referred to as functional recovery). The... Read More | Comment
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In an informal survey of nearly 2,500 anesthesiologists conducted by the American Society of Anesthesiologists, 98 percent of respondents said they “regularly experience drug shortages at their institutions.” More than 95 percent say those shortages impact the way they treat their patients. One reason behind the shortages is pharmaceutical industry consolidation — there are now fewer manufacturers than in the past. Grant explains that a... Read More | Comment
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Under our simulated conditions, anesthesia providers more correctly and quickly identified icon alarms than standard alarms. Subjects were more likely to perceive higher fatigue and task load when using current standard alarms than icon alarms. Twenty anesthesia providers were assigned to standard or icon groups. Experiments were conducted in a simulated intensive care unit. After a brief group-specific alarm orientation, subjects identified patient-associated alarm sounds... Read More | Comment
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Elective general surgery appears to be comparably safe at any time of the workday, any day of the workweek, and in any month of the year. The binary outcomes of 32,001 elective general surgical patients at the Cleveland Clinic between January 2005 and September 2010 were analyzed according to the hour of the day (6 am to 7 pm), day of the workweek, month of... Read More | Comment
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Predicted difficult airways in one emergency department are managed most often using rapid sequence intubation (RSI) and video laryngoscopy (VL), a recent study has found. Although difficult airways occur frequently in emergency medicine, few studies have investigated the incidence, management and outcomes of these patients, according to the investigators. Read More | Comment
Upvote Story 12
Versatile and safe, Ketamine can help with sedation, induction, asthma and pain. Can a shot of it even treat suicidality? New indications for Ketamine seem to be popping up every day. Its primary ED use is for procedural sedation, though the only FDA approved use is for induction of general anesthesia. It is also used off label as a medical restraint for patients with behavioral... Read More | Comment