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AnesthesiologyNews.com • M a r c h 2 0 1 4 • Volume 40 Number 3
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For Tracheostomy, Better Late Than … Early?
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oughly one-third of patients who undergo mechanical ventilation in the ICU undergo a tracheostomy. The procedure is thought to improve comfort and decrease the duration of mechanical ventilation, sedation, exposure and length of stay in the unit. For years, clinicians have been debating whether tracheostomies should be performed early or late, but what constitutes “early” or “late” has not been clear. Two studies presented at the 2014 annual meeting of the Society of Critical Care Medicine came to different conclusions regarding the benefits of early tracheostomy in patients undergoing mechanical ventilation.
Hypoxia After Surgery Much More Common Than Previously Believed Study finds high rate of prolonged bouts of desaturation on wards
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surprisingly largge fraction of patients exxperiences prrolonged periods of hyypoxemia whille recovering from surgery, n new research shows. Although the impliccations of the findings for patients are n not yet clear, exxperts said results suggest that efforts too monitor oxygen saturation on the ward are not nearly as effective as cllinicians might assume. “The way we’re doing it now is not proviiding physicians with what they reaally want, which is an early warning sign of respiratory distress,” said Daniel I. Sesssler, MD, chair of the
see early page 28
see hypoxia page 24
“I Felt Like an Old Fool”: Poor decisions and the loss of a medical career
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fter the state medical board he would be back with an order to revoke my controlled substance cerinvestigator’s second visit, I tificate, and in that case I would not was growing concerned. The charts he requested were patients who get it back for two years. After talking with my attorney, I decided to sign it. were somewhat problematic. Several months after I submitted a second I was in shock, but my main conPart 2 of 3 cern was for the patients who were group of charts, he came back with an depending on me for pain medicine. official board document. The agent told me that I could voluntarily surrender my state Another local physician who was willing to treat pain controlled substance certificate; I would have to pres- took a small number of my patients, but posted a sign ent my case at a hearing to see whether I could get saying he was not accepting any more from me. The it back. He said that if I did not sign the document, see taboo page 10
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PRN
Trauma patients exposed to increasing amounts of radiation.
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CLINICAL ANESTHESIOLOGY
Ultrasound guides percutaneous tracheostomy to better outcomes.
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CLINICAL ANESTHESIOLOGY
Managing pain after anorectal surgery— the surgeon’s take.
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POLICY & MANAGEMENT
Particulate steroids: too risky to use? A debate.
EDUCATIONAL REVIEW Nerve Monitors and Peripheral Blockade: Assuring Optimal Needle Placement, see insert at page 22.
NEW & FEATURED PRODUCTS see pages 11 and 23
see pages 24 and 43
4x4 Echogenic Corner Cube Reflector Needles (CCR) from Havel’s
ACTion Pain Pump MultiBolus II, from Ambu Inc.
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