Respiratory gas exchange during robotic-assisted laparoscopic radical prostatectomy.

Study Objective: Robotic-assisted laparoscopic prostatectomy requires patients to be secured in a steep Trendelenburg position for several hours. Added to the CO2 pneumoperitoneum that is created, this positioning invariably restricts diaphragmatic and chest wall excursion, which can adversely affect respiratory gas exchange. This study sought to measure the extent of respiratory gas change during this procedure.

Etomidate is still a valid anesthetic for electroconvulsive therapy.

Komatsu et al have recently written that the use of etomidate as an anesthetic induction agent for surgery is associated with increased 30-day mortality and cardiovascular morbidity, compared with propofol. Etomidate has long been recognized as suppressing adrenocortical function and, as an infusion over days, has been indicted in increasing intensive care unit patient mortality. Even in single doses, etomidate causes a reduction in cortisol production, although recovery from single-dose suppression is generally prompt.

Shoulder and head elevation improves laryngoscopic view for tracheal intubation in nonobese as well as obese individuals.

Study Objective: To determine whether shoulder and head elevation, such that the patient's ear lies at or higher than the sternum ("ramp"), improves laryngoscopic grade in adult patients of various body mass index (BMI) values.

Design: Prospective, unblinded study, with patients and laryngoscopists acting as their own controls.

Setting: Operating room of a university-affiliated hospital.

A randomized, open-label study of the safety and tolerability of fospropofol for patients requiring intubation and mechanical ventilation in the intensive care unit.

Background: Current drugs for induction and maintenance of sedation in mechanically ventilated patients in the intensive care unit have limitations. Fospropofol, a prodrug of propofol, has not been studied as a sedative in the ICU setting.

Methods: In this randomized, open-label pilot study, patients received 1 of 3 regimens with a goal of maintaining a Ramsay Sedation Score of 2 to 5: (1) fospropofol IV infusion with a bolus and increased infusion rate for agitation events (infusion/bolus); (2) fospropofol IV infusion with an increased infusion rate for agitation events (infusion only); or (3) propofol IV infusion with an increased infusion rate for agitation events.

Government spotlight on physicians' consulting arrangements with device makers.

A new government focus on investigating physicians' consulting agreements and other financial arrangements with device manufacturers has been announced. Physicians would be well advised to prepare for investigations by reviewing any agreements they have and assembling all related documents. This article outlines additional steps that will assist a physician in preparing for a government investigation.

Schedule the short procedure first to improve OR efficiency.

OPERATING ROOM MANAGERS are hampered in their efforts to optimize OR efficiency by surgical procedures that last a longer or shorter time than scheduled. The lack of predictability is a result of inaccuracy in scheduling and variability in the duration of procedures. SCHEDULING SHORT PROCEDURES before long procedures theoretically limits this variability.

Why can't my procedures start on time?

Despite OR practice improvements, approximately 50% of second or subsequent surgical procedures will not start on time because of procedure duration overruns caused by preceding procedures. Operating room scheduling that uses reliable historical data about specific surgeon and procedure combinations and computerized scheduling systems can minimize overruns. Statistical variability in procedure durations, however, implies that one-half of the procedures will run longer than the calculated mean, resulting in wait times for time-scheduled surgeons and their patients.

Malignant Hyperthermia and Electroconvulsive Therapy.

A 30-year-old man with a personal and family history of malignant hyperthermia and a 7-year history of psychiatric illness unresponsive to various psychotropic medications benefitted from electroconvulsive therapy given in combination with clozapine. Volatile inhalation anesthetics and a depolarizing muscle relaxant (succinylcholine) were assiduously avoided. Dantrolene was administered intravenously before the first treatment but was not used for the remainder of the treatments.