Validation of stroke volume and cardiac output by electrical interrogation of the brachial artery in normals: assessment of strengths, limitations, and sources of error.

The goal of this study is to validate a new, continuous, noninvasive stroke volume (SV) method, known as transbrachial electrical bioimpedance velocimetry (TBEV). TBEV SV was compared to SV obtained by cardiac magnetic resonance imaging (cMRI) in normal humans devoid of clinically apparent heart disease. Thirty-two (32) volunteers were enrolled in the study.

Postoperative subcutaneous instillation of low-dose ketorolac but not hydromorphone reduces wound exudate concentrations of interleukin-6 and interleukin-10 and improves analgesia following cesarean delivery.

Unlabelled: The objectives of this study were to test the effects of low-dose ketorolac and hydromorphone added to continuous local anesthetic wound instillation on surgical-site inflammatory mediators, postoperative pain, and opioid consumption. Sixty healthy women undergoing cesarean delivery were enrolled in this randomized, double-blinded study. Patients were randomized to receive a subcutaneous wound instillation of bupivacaine .

Mathematical method to build an empirical model for inhaled anesthetic agent wash-in.

Background: The wide range of fresh gas flow - vaporizer setting (FGF - FD) combinations used by different anesthesiologists during the wash-in period of inhaled anesthetics indicates that the selection of FGF and FD is based on habit and personal experience. An empirical model could rationalize FGF - FD selection during wash-in.

Methods: During model derivation, 50 ASA PS I-II patients received desflurane in O2 with an ADU® anesthesia machine with a random combination of a fixed FGF - FD setting.

Vancomycin plasma concentrations in cardiac surgery with the use of profound hypothermic circulatory arrest.

Objective: This study was undertaken to compare the effect of deep hypothermic circulatory arrest, compared with moderate hypothermia, on the plasma concentrations and pharmacokinetic profile of vancomycin, administered as prophylaxis, in patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: Two groups of adult cardiac surgery patients were prospectively studied. One group consisted of 12 patients undergoing valvular surgery with moderate hypothermia, and another group was of 12 patients undergoing surgery with the use of profound hypothermic circulatory arrest.

Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients.

Background: Morbid obesity and bariatric surgery are both risk factors for the development of postoperative rhabdomyolysis (RML). RML results from injury to skeletal muscle, and a serum creatine phosphokinase (CK) level >1,000 IU/L is considered diagnostic of RML. The aim of this study was to determine if intraoperative intravenous fluid (IVF) volume affects postoperative CK levels following laparoscopic bariatric operations.

Does a delay in performing an activated clotting (ACT) test really matter? A study in nonheparinized blood and a single ACT machine.

Activating clotting time (ACT) is a point-of-care, blood clotting test used to monitor anticoagulation. Recently, institutional requirements have required that ACT testing be completed outside the operating room with trained, certified personnel other than anesthesia staff. For this reason, in this study, we looked at whether a delay in processing an ACT makes a significant difference to the ACT results.

Regional anesthesia and obesity.

The potential advantages of regional anesthesia include minimal airway intervention, less cardiopulmonary depression, excellent postoperative analgesia, less postoperative nausea and vomiting, and shorter recovery room and hospital stays. These concerns are particularly important for the obese surgical patient. This review discusses the application of regional anesthetic techniques in obesity.

Intra-operative fluid volume influences postoperative nausea and vomiting after laparoscopic gastric bypass surgery.

Background: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is a commonly performed operation for morbid obesity. A significant number of patients experience postoperative nausea and vomiting (PONV) following this procedure. The aim of this study was to determine the effect, if any, of intra-operative fluid replacement on PONV.

Estimating blood volume in obese and morbidly obese patients.

Preoperative assessment of blood volume (BV) is important for patients undergoing surgery. The mean value for indexed blood volume ((In)BV) in normal weight adults is 70 mL/kg. Since (In)BV decreases in a non-linear manner with increasing weight, this value cannot be used for obese and morbidly obese patients.

Plasma cefazolin levels during cardiovascular surgery: effects of cardiopulmonary bypass and profound hypothermic circulatory arrest.

Objectives: We sought to assess the effects of cardiopulmonary bypass and profound hypothermic circulatory arrest on plasma cefazolin levels administered for antimicrobial prophylaxis in cardiovascular surgery.

Methods: Four groups (10 patients per group) were prospectively studied: vascular surgery without cardiopulmonary bypass (group A), cardiac surgery with a cardiopulmonary bypass time of less than 120 minutes (group B), cardiac surgery with a cardiopulmonary bypass time of greater than 120 minutes (group C), and cardiac surgery with cardiopulmonary bypass and profound hypothermic circulatory arrest (group D). Subjects received cefazolin at induction and a second dose before wound closure.

The dose of succinylcholine in morbid obesity.

The appropriate dose of succinylcholine (SCH) in morbidly obese patients is unknown. We studied 45 morbidly obese (body mass index >40 kg/m2) adults scheduled for gastric bypass surgery. The response to ulnar nerve stimulation of the adductor pollicis muscle at the wrist was recorded using the TOF-Watch SX acceleromyograph.

Estimating ideal body weight--a new formula.

A simple formula for estimating ideal body weight (IBW) in kilograms for both men and women is presented. The equation IBW = 22 x H2, where H is equal to patient height in meters, yields weight values midway within the range of weights obtained using published IBW formulae.

Tracheal width and left double-lumen tube size: a formula to estimate left-bronchial width.

Study Objective: To determine which patient parameters best predict left bronchial width (LBW) when selecting the correct size double-lumen tube (DLT). If LBW is known, a DLT that will fit that bronchus can be chosen.

Design: Prospective study.

The intubating laryngeal mask airway: rocuronium improves endotracheal intubating conditions and success rate.

Study Objective: To assess intubating conditions without neuromuscular blocking drugs, to determine the relation between the dose of rocuronium and the probability of achieving excellent or at least good (good or excellent) intubating conditions with the intubating laryngeal mask airway (ILMA), and finally, to determine the relationship between rocuronium use and the success rate of endotracheal intubation.

Design: Prospective, randomized, double-blinded, placebo-controlled study.

Setting: University-affiliated medical center.

Kidney transplantation: recent developments and recommendations for anesthetic management.

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. After receiving a transplant, survival rates are higher and comorbidities may resolve. As a consequence, more patients with significant comorbidities such as advanced cardiovascular disease will present for transplantation.

Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions.

Background: The effect of patient position on the view obtained during laryngoscopy was investigated.

Methods: 60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups.

Heat and moisture exchange devices: are they doing what they are supposed to do?

Unlabelled: Heat and moisture exchangers (HMEs) are used to provide humidification and warming of the inspiratory gases during general anesthesia. The performance specifications provided by manufacturers of HMEs are based on in vitro measurements of moisture output using the International Standards Organization (ISO) 9360 method. We studied the in vivo performance of three different HMEs with similar ISO specifications in a randomized crossover fashion in patients under general anesthesia.