Better Monitoring Reduces Post-op Respiratory Complications

Sending patients with obstructive sleep apnea (OSA) who are undergoing endoscopic sinus surgery (ESS) to the ICU for intensive monitoring during the first postoperative night improves respiratory complication–related outcomes | Anesthesiology News

Patients with OSA have a higher incidence of postoperative respiratory complications, according to researchers from Jikei University, in Tokyo. Certain procedures, such as ESS, may nix the use of post-op continuous positive airway pressure for sleep apnea, according to the researchers. They implemented a policy at their hospital, in 2011, that required all patients with documented or suspected OSA to be admitted to the ICU for monitoring following ESS.

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Translating e-pain research into patient care

McGuire, B.E. et al. (2017) Pain. 158(2) pp. 190–193

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Recently, a call was made to expand the availability of pain self-management for the public, but several obstacles limit access to pain services such as distance, cost, and availability. Technology-based interventions can help with access to pain management, and consideration of these opportunities is timely given service pressures, changing consumer preferences, and the burgeoning ownership of personal computers and smartphones. In that context, we have described (1) the features of e-pain technologies, (2) the challenges in developing e-pain technologies, (3) the existing evidence in relation to technology-based pain management, (4) the debate regarding regulation of e-pain treatments, and (5) the likely steps for future development of these interventions.

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The application of three-dimensional printing technology in anaesthesia

Chao, I. et al. Anesthesia. Published online: 27 January 2017 

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Three-dimensional printing has rapidly become an easily accessible, innovative and versatile technology, with a vast range of applications across a wide range of industries. There has been a recent emergence in the scientific literature relating to its potential application across a multitude of fields within medicine and surgery; however, its use within anaesthesia has yet to be formally explored. We undertook a systematic review using MEDLINE and EMBASE databases of three-dimensional printing in anaesthesia. We identified eight relevant articles. Due to the paucity of studies, we also completed a narrative review of the applications of three-dimensional printing pertinent to anaesthetic practice that our department are currently exploring, and suggest potential future uses for this technology relevant to our speciality.

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Smartphone-based behavioural intervention alleviates children’s anxiety during anaesthesia induction

Cumino, D. et al. European Journal of Anaesthesiology. Published online: 18 January 2017

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Background: Preoperative anxiety negatively influences children’s anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children’s anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial.

 

Conclusions: The behavioural distraction strategies using smartphones were effective in preventing an increase in children’s anxiety during anaesthesia induction.

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Choice of Anesthesia for Cesarean Delivery

Juang, J. et al. Anesthesia & Analgesia. Published online: January 16 2017

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Image source: Virginia Powell – Wellcome Images // CC BY-NC-ND 4.0

Neuraxial anesthesia use in cesarean deliveries (CDs) has been rising since the 1980s, whereas general anesthesia (GA) use has been declining.

In this brief report we analyzed recent obstetric anesthesia practice patterns using National Anesthesiology Clinical Outcomes Registry data. Approximately 218,285 CD cases were identified between 2010 and 2015. GA was used in 5.8% of all CDs and 14.6% of emergent CDs.

Higher rates of GA use were observed in CDs performed in university hospitals, after hours and on weekends, and on patients who were American Society of Anesthesiologists class III or higher and 18 years of age or younger.

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The management of pulmonary embolism

Lewis, J.E. & Pilcher, D.V. Anaesthesia & Intensive Care Medicine. Published online: 19 January 2017

Pulmonary embolism (PE) is a significant cause of hospitalization, morbidity and mortality and frequently triggers referral to critical care services. Critically ill patients are also at increased risk of developing venous thrombo-embolism (VTE) and acute PE.

Critical care clinicians should be confident in their approach to the patient with suspected and diagnosed PE. Furthermore, the co-morbid conditions in this patient group may present additional challenges both in diagnosis (e.g. safe access to radiology) and management (e.g. absolute and relative contraindications to anticoagulation/thrombolysis in critically ill patients).

This brief review summarizes the contemporary evidence base regarding both diagnosis and treatment strategies and draws upon this to suggest a simple algorithm for investigation, risk stratification and management, particularly tailored to patients within a critical care setting.

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Incidence of Connected Consciousness after Tracheal Intubation

Sanders, R.D. et al. (2017) Anesthesiology 2(126) pp. 214-222. 

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Background: The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice.

 

Conclusions: Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.

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