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  • 1
    Language: English
    In: Anesthesia and analgesia, 2001, Vol.92 (2), p.517-522
    Description: A fundamental skill of the anesthesiologist is airway management. We validated a simple endotracheal intubation algorithm with a large proportion of fiberoptic tracheal intubations used for years in daily practice. Over 2 yr, 13,248 intubations (〉90% of all intubations, including obstetrics and ear, nose, and throat patients) in a heterogeneous patient population at our acute care hospital were evaluated prospectively. About 80 physician and nurse anesthetists were involved. Once the indication for intubation (oral or nasal) was established, the first step was to choose between the primary conventional technique (laryngoscope with Macintosh blades) and the primary fiberoptic technique. For the conventional technique, a well defined procedure had to be followed (maximum of two attempts at intubation; if unsuccessful, switch to secondary oral fiberoptic intubation). For the primary fiberoptic technique, the anesthesiologist had to decide between nasotracheal intubation in awake patients and oral intubation in anesthetized patients. Fiberoptics were used for 13.5% of the intubations. By following our algorithm, intubation failed in 6 out of 13,248 cases (0.045%; 95% confidence interval 0.02%-0.11%). We demonstrate that a simple algorithm for endotracheal intubation, basically limited to fiberoptics as the only aid, is successful in daily practice. Only methods that are practiced daily can be used successfully in emergencies.
    Subject(s): Biological and medical sciences ; Anesthesia ; Medical sciences ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation ; Humans ; Middle Aged ; Child, Preschool ; Emergencies ; Infant ; Male ; Algorithms ; Adolescent ; Aged, 80 and over ; Adult ; Female ; Aged ; Intubation, Intratracheal ; Child ; Index Medicus ; Abridged Index Medicus
    ISSN: 0003-2999
    E-ISSN: 1526-7598
    Source: Hellenic Academic Libraries Link
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 2
    Language: English
    In: British journal of anaesthesia : BJA, 2008-01, Vol.100 (1), p.1-3
    Subject(s): Biomedical Research - methods ; Outcome and Process Assessment (Health Care) - methods ; Outcome and Process Assessment (Health Care) - standards ; Humans ; Quality of Health Care ; Patient Satisfaction ; Index Medicus
    ISSN: 0007-0912
    E-ISSN: 1471-6771
    Source: Alma/SFX Local Collection
    Source: Oxford Journals 2016 Current and Archive A-Z Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 3
    Language: English
    In: Anaesthesia, 2019-05, Vol.74 (5), p.630-637
    Description: Summary A decision by a society to sanction assisted dying in any form should logically go hand‐in‐hand with defining the acceptable method(s). Assisted dying is legal in several countries and we have reviewed the methods commonly used, contrasting these with an analysis of capital punishment in the USA. We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used. However, the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined. In voluntary assisted dying (in some US states and European countries), the common method to induce unconsciousness appears to be self‐administered barbiturate ingestion, with death resulting slowly from asphyxia due to cardiorespiratory depression. Physician‐administered injections (a combination of general anaesthetic and neuromuscular blockade) are an option in Dutch guidelines. Hypoxic methods involving helium rebreathing have also been reported. The method of capital punishment (USA) resembles the Dutch injection technique, but specific drugs, doses and monitoring employed vary. However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re‐awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane, and we have used lessons from the most recent studies of accidental awareness during anaesthesia to describe an optimal means that could better achieve unconsciousness. We found that the very act of defining an ‘optimum’ itself has important implications for ethics and the law.
    Subject(s): accidental awareness ; assisted suicide ; euthanasia ; medical ethics ; Coma ; Capital punishment ; Right to die ; Analysis ; Assisted suicide ; Medical ethics ; Euthanasia ; Index Medicus ; Abridged Index Medicus
    ISSN: 0003-2409
    E-ISSN: 1365-2044
    Source: Hellenic Academic Libraries Link
    Source: Wiley Online Library Science, Technology and Medicine Collection 2018
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 4
    Language: English
    In: British journal of anaesthesia : BJA, 2002-12, Vol.89 (6), p.863-872
    Description: We describe the development and comparison of a psychometric questionnaire on patient satisfaction with anaesthesia care among six hospitals. We used a rigorous protocol: generation of items, construction of the pilot questionnaire, pilot study, statistical analysis (construct validity, factor analysis, reliability analysis), compilation of the final questionnaire, main study, repeated analysis of construct validity and reliability. We compared the mean total problem score and the scores for the dimensions: ‘Information/Involvement in decision-making’, and ‘Continuity of personal care by anaesthetist’. The influence of potential confounding variables was tested (multiple linear regression). The average problem score from all hospitals was 18.6%. Most problems are mentioned in the dimensions ‘Information/Involvement in decision-making’ (mean problem score: 30.9%) and ‘Continuity of personal care by anaesthetist’ (mean problem score: 32.2%). The overall assessment of the quality of anaesthesia care was good to excellent in 98.7% of cases. The most important dimension was ‘Information/Involvement in decision-making’. The mean total problem score was significantly lower for two hospitals than the total mean for all hospitals (significantly higher at two hospitals) (P〈0.05). Amongst the confounding variables considered, age, sex, subjective state of health, type of anaesthesia and level of education had an influence on the total problem score and the two dimensions mentioned. There were only marginal differences with and without the influence of the confounding variables for the different hospitals. A psychometric questionnaire on patient satisfaction with anaesthesia care must cover areas such as patient information, involvement in decision-making, and contact with the anaesthetist. The assessment using summed scores for dimensions is more informative than a global summed rating. There were significant differences between hospitals. Moreover, the high problem scores indicate a great potential for improvement at all hospitals.
    Subject(s): measurement techniques, outcome ; research, anaesthesia ; anaesthesia, audit ; surgery ; Biological and medical sciences ; Anesthesia ; Miscellaneous ; Medical sciences ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Reproducibility of Results ; Humans ; Middle Aged ; Patient Participation ; Medical Audit ; Male ; Psychometrics ; Switzerland ; Patient Satisfaction ; Austria ; Adolescent ; Aged, 80 and over ; Adult ; Female ; Surveys and Questionnaires ; Aged ; Continuity of Patient Care - standards ; Anesthesia - standards ; Index Medicus
    ISSN: 0007-0912
    E-ISSN: 1471-6771
    Source: Alma/SFX Local Collection
    Source: Oxford Journals 2016 Current and Archive A-Z Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 5
    Article
    Article
    2008
    ISSN: 0007-0912 
    Language: English
    In: British journal of anaesthesia : BJA, 2008-01-01, Vol.100 (1), p.1
    ISSN: 0007-0912
    E-ISSN: 1471-6771
    Source: Alma/SFX Local Collection
    Source: Oxford Journals 2016 Current and Archive A-Z Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 6
    Language: English
    In: European journal of anaesthesiology, 2008-05, Vol.25 (Sup 44), p.88
    ISSN: 0265-0215
    E-ISSN: 1365-2346
    Source: Hellenic Academic Libraries Link
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  • 7
    Language: English
    In: Anesthesia and analgesia, 2000-09, Vol.91 (3), p.767-768
    Subject(s): Gangrene - etiology ; Myeloproliferative Disorders - complications ; Fingers ; Thrombocytosis - complications ; Humans ; Catheterization, Peripheral - adverse effects
    ISSN: 0003-2999
    E-ISSN: 1526-7598
    Source: Hellenic Academic Libraries Link
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  • 8
    Language: English
    In: Anesthesia and analgesia, 1998, Vol.86 (4), p.847-849
    Subject(s): Biological and medical sciences ; Anesthesia ; Medical sciences ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Local anesthesia. Pain (treatment) ; Blood Pressure ; Anesthesia, Epidural - adverse effects ; Humans ; Male ; Arthroplasty, Replacement, Hip - adverse effects ; Blood Loss, Surgical ; Prosthesis Failure ; Bradycardia - etiology ; Fatal Outcome ; Blood Volume ; Heart Arrest - etiology ; Aged ; Elective Surgical Procedures ; Hypotension, Controlled - adverse effects ; Resuscitation ; Index Medicus ; Abridged Index Medicus
    ISSN: 0003-2999
    E-ISSN: 1526-7598
    Source: Hellenic Academic Libraries Link
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 9
    Language: English
    In: Clinical chemistry and laboratory medicine, 1998, Vol.36 (4), p.235-240
    Description: Conventional laboratory investigations of haemostasis like prothrombin time and activated partial thromboplastin time are not useful in predicting and managing intra-operative bleeding complications. In order to establish a possible "perioperative reference range" for thrombin generation prothrombin fragment F1+2 (F1+2) and fibrin degradation (D-dimer) markers, we measured F1+2 and D-dimer concentrations before surgery (but after induction of anaesthesia), 30 minutes into surgery, 10 minutes after the event expected to induce the maximal activation of the haemostatic systems, 90 minutes after surgery and on postoperative days 1 and 2 in 226 consecutive patients. Samples were collected from arterial lines. Twenty patients developed a clinically defined, intraoperative disorder of haemostasis, 206 did not. Patients with an intraoperative disorder of haemostasis had significantly higher preoperative F1+2 and D-dimer concentrations. Preoperative values for F1+2 and D-dimer concentrations above the 75th percentile of patients without an intraoperative disorder of haemostasis indicated a 2.70 to 2.88 fold risk of developing an intraoperative disorder of haemostasis (odds ratios were 3.04, 3.12 and 3.29 for D-dimer, ELISA, F1+2, and D-dimer latex tests, respectively with 95% confidence intervals from 1.20 to 8.46) with negative predictive values of 94%, but positive predictive values of only 16% to 26%. These data suggest that preoperative determination of molecular markers might be helpful in identifying a group of patients at high risk for intraoperative disorder of haemostasis by exclusion of low risk patients. Validation of such an approach requires a prospective trial.
    Subject(s): Blood coagulation ; Biological and medical sciences ; Investigative techniques, diagnostic techniques (general aspects) ; Medical sciences ; Blood Loss, Surgical - prevention & control ; Intraoperative Complications - blood ; Blood Coagulation Disorders - prevention & control ; Fibrin Fibrinogen Degradation Products - metabolism ; Blood Coagulation Disorders - etiology ; Humans ; Middle Aged ; Risk Factors ; Intraoperative Complications - prevention & control ; Male ; Biomarkers - blood ; Hemostasis ; Intraoperative Complications - etiology ; Blood Coagulation ; Peptide Fragments - blood ; Aged, 80 and over ; Blood Coagulation Disorders - blood ; Adult ; Female ; Aged ; Prothrombin - metabolism ; Index Medicus
    ISSN: 1434-6621
    E-ISSN: 1437-4331
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 10
    Language: English
    In: European journal of anaesthesiology, 2001, Vol.18 (Supplement 21), p.3-4
    ISSN: 0265-0215
    E-ISSN: 1365-2346
    Source: Alma/SFX Local Collection
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