The Net Guide: Anesthesiology

NOVEMBER 02, 2010
//MEDICAL WEBSITES
American Society of Anesthesiologists
With information on the latest news in the anesthesiology field, upcoming webinars and meetings, educational articles, and articles on research, this site provides anesthesiologists with a wealth of information that shouldn’t be missed. The ASA has been educating and serving as a resource to anesthesiologists since 1905. In addition to physician educational items, the site contains information on bylaws, the ASA strategic plan, history, and more. Physicians can find information on continuing education as well.
 
//THE EDUCATED PATIENT

Patient Care – Anesthesiology, Yale University
Patients can learn the facts about anesthesiology and anesthesiologists at Yale’s Anesthesiology website. Here, visitors can read about statistics and figures such as the following: “More than 25 million surgical procedures are performed each year in the United States” and “Complications from anesthesia have declined dramatically over the last 30 years.” To the left, visitors can click on related articles, including one on Pain Management and how it’s related to the field of anesthesiology. Similarly, there is an article on “Pre-Admission Testing” that sheds some light on what patients can expect. There are also answers to frequently asked questions.
 
Information for Patients – Anesthesiology and Critical Care Medicine
This portion of the Johns Hopkins Medicine site is designated for patients and offers information on safety measures and what to expect when staying at the hospital and undergoing surgery. By clicking on Preoperative Roadmap, visitors are taken to a guide that lists “the important steps that are taken before a patient receives anesthesia to ensure that each patient receives the best possible care.” In addition, patients can click on the Patient Safety Brochure to learn more about how to become “more involved with their care in the hospital.”
 
//ONLINE CME
Lesson S13: PreAnesthetic Assessment of the Patient with a History of Intraoperative Awareness
Credits: 2.00
Fee: $15.00
Expires: July 31, 2011
Multimedia: NONE
This activity covers the definition of intraoperative awareness, “describes diagnostic instruments used for the recognition of awareness,” “cites risk factors for awareness,” “discusses the psychological impact of awareness,” “outlines a management plan for the patient,” and more.

Lesson 286: Preanesthetic Assessment of the Patient with Goodpasture’s Syndrome
Credits: 2.00
Fee: $15.00
Expires: June 30, 2011
Multimedia: NONE
This activity “defines GS,” ‘reviews special problems associated with the administration of anesthetics to patients with GS,” “describes the pulmonary and renal manifestation” seen in GS patients, “explains the pathogenesis of GS,” and more.
 
Anesthesia for Major Hepatic Resection
Credits: 1.00
Fee: Free
Expires: November 16, 2010
Multimedia: None
This program reviews “the regulation and alteration of hepatic blood flow,” “the concept of permissive hypotension,”
and “the anesthetic agents and techniques used during elective or traumatic hepatic resection.”
 

//eABSTRACTS
Ultrasound Decreases the Failed Labor Epidural Rate in Resident Trainees
Journal: International Journal of Obstetric Anesthesia (August 7, 2010)
Authors: Vallejo M, Phelps A, Singh S, et al
Purpose: The study was designed to “determine if ultrasound measurement of the depth from skin to epidural space before the epidural technique decreases the failure rate of labor analgesia.” The researchers also sought to “correlate ultrasound depth to the epidural space with actual depth of the needle at placement.”
Results: The prospective, randomized, non-blinded study included 370 parturients that requested labor epidural analgesia. The patients were “randomized to receive their epidural technique by first year anesthesia residents with or without prior ultrasound determination of epidural space depth. The results demonstrated that the “ultrasound group had fewer epidural catheter replacements, and placement attempts compared to the control group.” The researchers concluded that “ultrasound depth before epidural technique placement decreases the rate of epidural catheter replacements for failed labor analgesia, and reduces the number of epidural attempts when performed by first year residents and compared to attempts without ultrasound guidance.”

Pregnancy Does Not Enhance Volatile Anesthetic Sensitivity on the Brain: An Electroencephalographic Analysis Study
Journal: Anesthesiology (August 5, 2010)
Authors: Ueyama H, Hagihira S, Takashina M, et al
Purpose: The study is designed to “investigate the differences in the hypnotic effect of sevoflurane on parturients
and nonpregnant patients.”
Results: The electroencephalographic study included “15 parturients undergoing
cesarean section and 15 patients undergoing elective gynecologic surgery.” Anesthesia was induced and maintained with sevoflurane and fentanyl. Electoencephalographic signals were recorded by computer. The results demonstrated that there were no significant differences in electroencephalographic parameters in pregnant and nonpregnant women. The researchers concluded that “pregnancy does not enhance
hypnotic effect of sevoflurane.”
 
Comparative Efficacy of Ultrasound-Guided and Stimulating Popliteal-sciatic Perineural Catheters for Postoperative Analgesia
Journal: Canadian Journal of Anaesthesia (August 11, 2010)
Authors: Mariano E, Loland V, Sandhu N, et al
Purpose: The researchers sought to test “the hypothesis that popliteal-sciatic perineural catheter insertion relying exclusively on ultrasound guidance results
in superior postoperative analgesia compared with stimulating catheters.”
Results: The study included 80 subjects, which were randomized into two treatment groups. A group of 40 subjects were placed in the ultrasound group, while the remaining 40 were placed in the stimulating catheter group. Only one subject in the ultrasound
group “failed catheter placement per protocol, versus nine in the other group.” In addition, pain scores on postoperative day one of the ultrasound group were “somewhat higher” than for the other group. Researchers concluded that for “popliteal-sciatic perineural catheters, ultrasound guidance takes less time and results in fewer placement
failures,” but “analgesia may be mildly improved with successfully placed stimulating catheters.”

Anesthetic Risk Factors Associated with Early Mortality in Pediatric Liver Transplantation
Journal: Transplantation Proceedings (July 2010)
Authors: Castañeda-Martínez P, Alcaide-Ortega R, Fuentes-García V, et al
Purpose: The researchers wanted to “identify anesthetic risk factors associated with early mortality in pediatric patients who undergo liver transplantation.”
Results: The retrospective study investigated patients that “underwent
deceased or living donor liver transplantation.” The team “evaluated demographic variables of age, weight, gender, degree of malnutrition, and etiology.”
They also measured qualitative variables, including anesthesia time, bleeding, massive transfusion, and more. The results demonstrated that there were higher numbers of deaths associated with malnutrition, massive
bleeding, preperfusion metabolic acidosis, posttransplant hyperglycemia, and post perfusion hyperlactemia in the group of patients that died earlier versus the normal control group.

Propensity Scores in Intensive Care and Anaesthesiology Literature: A Systematic Review
Journal: Intensive Care Medicine (August 6, 2010)
Authors: Gayat E, Pirracchio R, Resche-Rigon M, et al
Purpose: The researchers sought “to assess the use and the quality of reporting of PS studies in intensive care and anaesthesiology, and to evaluate how past reviews have influenced
the quality of the reporting.” The team examined characteristics of the report, “the type of analysis, the details of matching procedures, the number of patients in treated and control groups,” and more.
Results: The researchers evaluated 47 “articles published between 2006 and 2009” in intensive care and anesthesiology
literature. They then selected 26 articles and found that “12 used stratification
on PS and 9 used adjustment on PS.” “The method used was reported in 81% of the articles, and the choice to conduct a paired analysis was reported in only 15%.” The researchers concluded that the “quality of reporting propensity scores in intensive care and anaesthesiology
literature should be improved” and provided some recommendations.
 
//CLINICAL TRIALS
Gas Kinetics and Metabolism in Anesthesia During Non Steady State
Study Type: Observational
Age/Gender Requirements: 18 years (male/female)
Sponsor: University of California, Irvine
Purpose: Researchers seek to better understand “how O2 and CO2 kinetics monitoring can define systems pathophysiology” in order to “greatly enhance safety in anesthesia by detecting critical events.”
 
Regional Anesthesia in Colon Rectal Surgery
Study Type: Interventional
Age/Gender Requirements: 18-85 years (male/female)
Sponsor: Outcomes Research Consortium
Purpose: The “study will compare recurrence rates in patients with colorectal cancer.” The patients “will be randomly assigned to epidural anesthesia/analgesia combined with general anesthesia or to general anesthesia followed by opioid analgesia.”

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