About J. Lance Lichtor

Posts by J. Lance Lichtor:

The Nexfin is an non-invasive monitor of of cardiac output. Does it work? How does it compare to thermodilution measured using a pulmonary artery catheter?

By in Audio, Technology, Computing, and Simulation

The Nexfin is an non-invasive monitor of of cardiac output. Does it work? How does it compare to thermodilution measured using a pulmonary artery catheter?

Cardiac output is classically measured using thermodilution, which requires a pulmonary artery catheter (PAC).  Pulmonary artery catheters are invasive and, as highlighted in 2 posts last month on AA2day (post 1; post 2), have multiple risks. The Nexfin determines cardiac output by analyzing the arterial pulse contour using an inflatable finger cuff.  In the article “Noninvasive […]

Use caution when placing a magnet to pacemakers or defibrillators before surgery

By in Audio, Patient Safety

Use caution when placing a magnet to pacemakers or defibrillators before surgery

The American Society of Anesthesiologists advises against the routine use of a magnet over an implantable cardioverter-debrillator or pacemaker in its 2011 Practice Advisory for cardiac implantable external devices (CIEDs). Instead, the ASA advice is to interrogate the device to assess function. In this month’s issue of Anesthesia & Analgesia, the article “Use Caution When […]

Postoperative hyperchloremia is associated with worse outcome than normal plasma chloride

By in Audio, Patient Safety

Outcome, including mortality and hospital stay, is worse if a patient becomes hyperchloremic postoperatively. Image source: Thinkstock

Most of us use lactated Ringer’s solution for fluid therapy intraoperatively, though in some institutions the preferred solution is normal saline.  Normal saline’s chloride concentration is 154 mEq/l, substantially higher than typical serum chloride concentration (100-100 mEq/l).  Given saline’s higher chloride concentration, do patients who receive that solution get hyperchloremic acidosis?  If they do, what […]

Even when sugammadex is used, residual paralysis persists in the PACU

By in Anesthetic Pharmacology

Even when sugammadex is used, residual paralysis persists in the PACU

Most anesthesia providers in this country, and in Japan, do not monitor neuromuscular function despite evidence that quantitative neuromuscular monitoring is associated with a lower risk of morbidity, including muscle weakness, critical respiratory events and length of PACU stay. Pity the patient who wakes up feeling weak after surgery because the anesthesia provider is unwilling […]

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