Pub Date : 2017-08-01DOI: 10.1097/01.SA.0000525621.77704.76
I. Smith, B. Pearse, D. Faulke, Rishendran R Naidoo, Lisa Nicotra, P. Hopkins, E. Ryan
{"title":"Targeted Bleeding Management Reduces the Requirements for Blood Component Therapy in Lung Transplant Recipients","authors":"I. Smith, B. Pearse, D. Faulke, Rishendran R Naidoo, Lisa Nicotra, P. Hopkins, E. Ryan","doi":"10.1097/01.SA.0000525621.77704.76","DOIUrl":"https://doi.org/10.1097/01.SA.0000525621.77704.76","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87993245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/01.sa.0000525615.53047.aa
M. Baxter, M. Alvarado
P reclinical animal studies have resulted in retrospective and prospective studies in humans regarding the safety of pediatric anesthesia. The possibility of adverse neurocognitive outcomes associated with repeated or prolonged pediatric anesthesia is worrisome. The latest investigation by Coleman et al also investigates the impact of exposure to general anesthesia in infancy on neurobehavioral development in nonhuman primates. This is a translationally relevant model as the stage of brain development at birth of a rhesus monkey is similar to that of a 6-month-old human infant. Also, physiologicmonitoring and support are more viable in the case of an infant monkey rather than with an infant rodent. Hence, the study by Coleman et al provides
{"title":"Monkey in the Middle: Translational Studies of Pediatric Anesthetic Exposure.","authors":"M. Baxter, M. Alvarado","doi":"10.1097/01.sa.0000525615.53047.aa","DOIUrl":"https://doi.org/10.1097/01.sa.0000525615.53047.aa","url":null,"abstract":"P reclinical animal studies have resulted in retrospective and prospective studies in humans regarding the safety of pediatric anesthesia. The possibility of adverse neurocognitive outcomes associated with repeated or prolonged pediatric anesthesia is worrisome. The latest investigation by Coleman et al also investigates the impact of exposure to general anesthesia in infancy on neurobehavioral development in nonhuman primates. This is a translationally relevant model as the stage of brain development at birth of a rhesus monkey is similar to that of a 6-month-old human infant. Also, physiologicmonitoring and support are more viable in the case of an infant monkey rather than with an infant rodent. Hence, the study by Coleman et al provides","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81847951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/01.sa.0000525647.48445.c1
T. Kratz, T. Steinfeldt, M. Exner, M. C. DellʼOrto, N. Timmesfeld, C. Kratz, M. Skrodzki, H. Wulf, M. Zoremba
Perioperative hemodynamic monitoring and intervention using transthoracic echocardiography (TTE) in highrisk surgery patients can decrease the rates of adverse events, morbidity, and mortality; however, evidence regarding its benefits is required. This prospective interventional study aimed at evaluating the efficacy of intraoperative TTE to alter patient management in high-risk and extensively monitored surgical patients susceptible to hemodynamic instability. The study included 52 hemodynamically unstable high-risk abdominal, vascular, or thoracic surgery patients. Patients were anesthetized, and focused TTE was performed when intraoperative hemodynamic instability occurred (hypotension or low cardiac output for a period of ≥3 minutes). Cardiac output monitoring system using pulse contour analysis was established before induction of anesthesia. The definitive therapy leading to an alteration of management was guided by the results of the focused TTE. Differences between intended and actual therapies and changes in management were documented as the primary end points. The analysis of TTE quality and description of pathophysiologic cardiovascular findings were the secondary end points. Sample size estimation and statistical analyses were performed with the statistical software R (www.r-project.org). Changes of management were noted in 33 patients (66%; 95% confidence interval, 52.11%–77.61%) and 38 hemodynamic situations (46.34%; 95% confidence interval, 35.95%–57.06%) of the 50 hemodynamically unstable patients examined by additional focused TTE. Transthoracic echocardiography identified pathologic findings in 47 patients: hypovolemia (66%), left ventricular dysfunction (8%), right ventricular overload (22%), and right-sided heart failure (4%). Lack of randomization and the absence of a control group were the major limitations of this study.
{"title":"Impact of Focused Intraoperative Transthoracic Echocardiography by Anaesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients","authors":"T. Kratz, T. Steinfeldt, M. Exner, M. C. DellʼOrto, N. Timmesfeld, C. Kratz, M. Skrodzki, H. Wulf, M. Zoremba","doi":"10.1097/01.sa.0000525647.48445.c1","DOIUrl":"https://doi.org/10.1097/01.sa.0000525647.48445.c1","url":null,"abstract":"Perioperative hemodynamic monitoring and intervention using transthoracic echocardiography (TTE) in highrisk surgery patients can decrease the rates of adverse events, morbidity, and mortality; however, evidence regarding its benefits is required. This prospective interventional study aimed at evaluating the efficacy of intraoperative TTE to alter patient management in high-risk and extensively monitored surgical patients susceptible to hemodynamic instability. The study included 52 hemodynamically unstable high-risk abdominal, vascular, or thoracic surgery patients. Patients were anesthetized, and focused TTE was performed when intraoperative hemodynamic instability occurred (hypotension or low cardiac output for a period of ≥3 minutes). Cardiac output monitoring system using pulse contour analysis was established before induction of anesthesia. The definitive therapy leading to an alteration of management was guided by the results of the focused TTE. Differences between intended and actual therapies and changes in management were documented as the primary end points. The analysis of TTE quality and description of pathophysiologic cardiovascular findings were the secondary end points. Sample size estimation and statistical analyses were performed with the statistical software R (www.r-project.org). Changes of management were noted in 33 patients (66%; 95% confidence interval, 52.11%–77.61%) and 38 hemodynamic situations (46.34%; 95% confidence interval, 35.95%–57.06%) of the 50 hemodynamically unstable patients examined by additional focused TTE. Transthoracic echocardiography identified pathologic findings in 47 patients: hypovolemia (66%), left ventricular dysfunction (8%), right ventricular overload (22%), and right-sided heart failure (4%). Lack of randomization and the absence of a control group were the major limitations of this study.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84837991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/SA.0000000000000334
T. Archer
{"title":"Transthoracic echocardiography and electrical cardiometry elucidate the hemodynamics of autotransfusion during labor under epidural analgesia.","authors":"T. Archer","doi":"10.1097/SA.0000000000000334","DOIUrl":"https://doi.org/10.1097/SA.0000000000000334","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86589038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/01.sa.0000525623.85327.92
J. Russell
{"title":"Vasopressin, Norepinephrine, and Vasodilatory Shock After Cardiac Surgery: Another “VASST” Difference?","authors":"J. Russell","doi":"10.1097/01.sa.0000525623.85327.92","DOIUrl":"https://doi.org/10.1097/01.sa.0000525623.85327.92","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78399978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/01.sa.0000525614.45424.ba
K. Mason
This article considers the evolution of emergence delirium (ED) and emergence agitation since it was first identified in the 1960s to assess present and future trends in identification, treatment, and prognostic value. There is a need for well-designed large prospective studies to assess ED risk factors and eliminate confounders as well as a need for standardized screening, evaluation tools, and data sharing in order to easily compare outcomes for researchers of pediatric ED (characterized by crying, sobbing, thrashing about, and disorientation following anesthesia). Emergence delirium should therefore be considered a “vital sign” to be consistently documented in the pediatric postanesthesia recovery period. The Paediatric Anaesthesia Emergence Delirium (PAED) scale, which assigns scores based on exhibited behavior, is used to identify ED currently. Because of problems in assessing normal behavior in children (especially those with special needs) in a stressful clinical environment, a better protocol is needed. A baseline preoperative and postoperative PAEDwould be useful to provide a comparative reference point in the recovery room and reduce the risk of falsepositive results. Routine monitoring and preoperative and postoperative PAED scores treated as vital signs in the pediatric units will yield better ED assessments and care. The best approach to reducing ED should be preventing its occurrence rather than treating the symptoms and pain with α2-adrenergic agonists. Standardized and routine monitoring of ED will ensure better understanding of the risk factors and prevention of this phenomenon leading to better delivery of care to children and faster recovery in the postoperative setting.
{"title":"Paediatric Emergence Delirium: A Comprehensive Review and Interpretation of the Literature","authors":"K. Mason","doi":"10.1097/01.sa.0000525614.45424.ba","DOIUrl":"https://doi.org/10.1097/01.sa.0000525614.45424.ba","url":null,"abstract":"This article considers the evolution of emergence delirium (ED) and emergence agitation since it was first identified in the 1960s to assess present and future trends in identification, treatment, and prognostic value. There is a need for well-designed large prospective studies to assess ED risk factors and eliminate confounders as well as a need for standardized screening, evaluation tools, and data sharing in order to easily compare outcomes for researchers of pediatric ED (characterized by crying, sobbing, thrashing about, and disorientation following anesthesia). Emergence delirium should therefore be considered a “vital sign” to be consistently documented in the pediatric postanesthesia recovery period. The Paediatric Anaesthesia Emergence Delirium (PAED) scale, which assigns scores based on exhibited behavior, is used to identify ED currently. Because of problems in assessing normal behavior in children (especially those with special needs) in a stressful clinical environment, a better protocol is needed. A baseline preoperative and postoperative PAEDwould be useful to provide a comparative reference point in the recovery room and reduce the risk of falsepositive results. Routine monitoring and preoperative and postoperative PAED scores treated as vital signs in the pediatric units will yield better ED assessments and care. The best approach to reducing ED should be preventing its occurrence rather than treating the symptoms and pain with α2-adrenergic agonists. Standardized and routine monitoring of ED will ensure better understanding of the risk factors and prevention of this phenomenon leading to better delivery of care to children and faster recovery in the postoperative setting.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91507490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/01.SA.0000525622.77704.ad
J. Irons, L. Miles, K. Joshi, A. Klein, M. Scarci, P. Solli, G. Martinez
A lthough deemed mandatory to provide safe and optimal operating conditions for surgical manipulation, general anesthesia with endobronchial intubation and 1-lung positive-pressure ventilation for thoracic surgery has been known to cause lung injury. Nonintubated thoracic anesthetic techniques for video-assisted thoracoscopic surgery (VATS) in awake and sedated patients can be an alternate method to decrease the overall invasiveness and surgical stress. A nonintubated general anesthetic technique with airway support via a supraglottic airway device with the patient awake or under sedation was developed. A retrospective observational study was conducted to compare the nonintubated general anesthetic technique to an intubated general anesthesia group for minor VATS procedures.
{"title":"Thoracic Anesthesia Intubated Versus Nonintubated General Anesthesia for Video-Assisted Thoracoscopic Surgery—A Case-Control Study","authors":"J. Irons, L. Miles, K. Joshi, A. Klein, M. Scarci, P. Solli, G. Martinez","doi":"10.1097/01.SA.0000525622.77704.ad","DOIUrl":"https://doi.org/10.1097/01.SA.0000525622.77704.ad","url":null,"abstract":"A lthough deemed mandatory to provide safe and optimal operating conditions for surgical manipulation, general anesthesia with endobronchial intubation and 1-lung positive-pressure ventilation for thoracic surgery has been known to cause lung injury. Nonintubated thoracic anesthetic techniques for video-assisted thoracoscopic surgery (VATS) in awake and sedated patients can be an alternate method to decrease the overall invasiveness and surgical stress. A nonintubated general anesthetic technique with airway support via a supraglottic airway device with the patient awake or under sedation was developed. A retrospective observational study was conducted to compare the nonintubated general anesthetic technique to an intubated general anesthesia group for minor VATS procedures.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87033188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/01.sa.0000527498.71626.89
D. Bishop, R. Rodseth, R. A. Dyer
{"title":"Context is king - obstetric anaesthesia management strategies in limited resource settings.","authors":"D. Bishop, R. Rodseth, R. A. Dyer","doi":"10.1097/01.sa.0000527498.71626.89","DOIUrl":"https://doi.org/10.1097/01.sa.0000527498.71626.89","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73897457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1097/SA.0000000000000319
A. Joosten, O. Desebbe, K. Suehiro, L. Murphy, M. Essiet, B. Alexander, M. Fischer, L. Barvais, L. Obbergh, D. Maucort-Boulch, M. Cannesson
The main purpose of this article is to provide a systematic review of all medical literature (37 studies; 1543 patients) comparing cardiac output (CO) measured with a commercially available completely noninvasive CO monitoring device against bolus thermodilution (TD) in various clinical settings such as the intensive care unit, emergency department, and the operating room. In addition, the authors provide a meta-analysis of the data extracted from the systematic review to calculate the precision of these noninvasive CO monitoring devices when used perioperatively by following pooled estimates. The authors gathered data from the systematic review in order to calculate the following 4 variables: (1) the pooled estimate of the mean difference between the tested method of bolus TD and the noninvasive reference method (bias), (2) the pooled estimate of the standard deviation (precision) of the bias, (3) the pooled estimate of the 95% confidence intervals of the bias, and (4) the pooled estimate of the percentage of error (PE). An acceptable agreement between the tested and the reference method was defined as a pooled estimate (PE) of 30% or greater. Despite it being crucial in critical care management, CO, the basis of measuring oxygen delivery to end organs, has been demonstrably undermonitored in clinical settings. New noninvasive techniques and older methods abound for monitoring CO including pulse wave transit time (PWTT), noninvasive pulse contour analysis (niPCA), partial CO2 rebreathing (CO2r), and thoracic electrical bioimpedance (TEB), yet the “go-to” in the clinical setting is the traditional invasive technique of bolus TD. Mean CO was 4.78 L/min in both methods. The overall random-effects pooled bias was −0.13 L/min (−2.38 to 2.12 L/min) and PE 47% with high interstudy sensitivity heterogeneity (I = 83%, P < 0.001). Despite the many advances in medical technology since the early 2000s, both TEB and CO2r have not shown significantly increased agreement when compared with bolus TD (PE for TEB was 37% in 1999, 43% in 2010, and 42% in 2016 in this metaanalysis; CO2r PE was similar to 2010: 44.5% against 40% in this meta-analysis). Recent techniques, such as PWTTand the niPCA, have a PE of 62% for PWTT and 45% for niPCA. Completely noninvasive technologies for the measurement of CO did not reach an acceptable level of agreement. The PEs of all noninvasive techniques were above the preset threshold of 30%, and the
{"title":"Accuracy and Precision of Non-invasive Cardiac Output Monitoring Devices in Perioperative Medicine: A Systematic Review and Meta-analysis","authors":"A. Joosten, O. Desebbe, K. Suehiro, L. Murphy, M. Essiet, B. Alexander, M. Fischer, L. Barvais, L. Obbergh, D. Maucort-Boulch, M. Cannesson","doi":"10.1097/SA.0000000000000319","DOIUrl":"https://doi.org/10.1097/SA.0000000000000319","url":null,"abstract":"The main purpose of this article is to provide a systematic review of all medical literature (37 studies; 1543 patients) comparing cardiac output (CO) measured with a commercially available completely noninvasive CO monitoring device against bolus thermodilution (TD) in various clinical settings such as the intensive care unit, emergency department, and the operating room. In addition, the authors provide a meta-analysis of the data extracted from the systematic review to calculate the precision of these noninvasive CO monitoring devices when used perioperatively by following pooled estimates. The authors gathered data from the systematic review in order to calculate the following 4 variables: (1) the pooled estimate of the mean difference between the tested method of bolus TD and the noninvasive reference method (bias), (2) the pooled estimate of the standard deviation (precision) of the bias, (3) the pooled estimate of the 95% confidence intervals of the bias, and (4) the pooled estimate of the percentage of error (PE). An acceptable agreement between the tested and the reference method was defined as a pooled estimate (PE) of 30% or greater. Despite it being crucial in critical care management, CO, the basis of measuring oxygen delivery to end organs, has been demonstrably undermonitored in clinical settings. New noninvasive techniques and older methods abound for monitoring CO including pulse wave transit time (PWTT), noninvasive pulse contour analysis (niPCA), partial CO2 rebreathing (CO2r), and thoracic electrical bioimpedance (TEB), yet the “go-to” in the clinical setting is the traditional invasive technique of bolus TD. Mean CO was 4.78 L/min in both methods. The overall random-effects pooled bias was −0.13 L/min (−2.38 to 2.12 L/min) and PE 47% with high interstudy sensitivity heterogeneity (I = 83%, P < 0.001). Despite the many advances in medical technology since the early 2000s, both TEB and CO2r have not shown significantly increased agreement when compared with bolus TD (PE for TEB was 37% in 1999, 43% in 2010, and 42% in 2016 in this metaanalysis; CO2r PE was similar to 2010: 44.5% against 40% in this meta-analysis). Recent techniques, such as PWTTand the niPCA, have a PE of 62% for PWTT and 45% for niPCA. Completely noninvasive technologies for the measurement of CO did not reach an acceptable level of agreement. The PEs of all noninvasive techniques were above the preset threshold of 30%, and the","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78737138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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