How to Save $200,000.00 in Anesthetic Agent

Due to the current health care reform legislation many hospitals are implementing recommendations from the "Institute for Health care Improvement" in  regards to reducing or eliminating wasted time, money, and energy in health care.
One area to eliminate waste and to increase savings is focusing on anesthetic agent use during general anesthesia procedures.

Apneic Oxygenation Diffusion to Determine Apnea: Is it Safe?

The apnea test is a component in the determination of brain death. One technique used to evaluate the absence of breathing drive is to perform the "Apneic Oxygenation Diffusion Technique" also know as a "CO2 Challenge". In 1995 the American Academy of Neurology published prerequisites and parameters to perform this clinical assessment[1].

In his recent journal article "A Critique of the Apneic Oxygenation Test for the Diagnosis of Brain Death"[2], Dr. James Tibballs provides a strong argument against the utility and questions the safety of the apnea test.

The author proposes four areas of concern to fortify his disagreement:

1. The reliability of apnea with a rise in PaCO2 as a neurological diagnostic of brain death.
2. The potential for injury due to the unpredictable rise in PaCO2.
3. The large amount of variability, in regards to performance of the technique.
4. There are other tests which can be performed, which are superior. 

TRENDS ASSOCIATED WITH FAILED WEANING INDICES

This Abstract was originally presented at the AARC 2007 Open Forum

Background:
The Successful wean & extubation of ventilated patients decreases hospital length of stay and reduces morbidity and mortality. One tool utilized to facilitate this process is “wean predictors” incorporated into RCP driven protocols to determine whether a patient may advance to a spontaneous breathing trial (SBT).
Hypothesis: Patients are less probable to be placed on a SBT due to weaning predictors that are not within the RCP’s scope of practice vs. predictors, which can be manipulated/controlled, by the RCP.
Design: Single center, nonrandomized, prospective, convenience cohort.
Setting- 18 bed general ICU. Patients- 91 adult patients requiring mechanical ventilation > 24 hours, admitted to the ICU between June 2006 and March 2007.

Adaptive Pressure Control Ventilation during Anesthesia: A False sense of Security

Adaptive pressure control (APC) is a ventilator modality which has been applied safely in intensive care units for greater than a decade. The mode delivers a pressure control breath that maintains a target tidal volume (Vt) at the lowest possible pressure, independently of changes in pulmonary mechanics.

Within the last few years in the United States ventilator manufactures have made this mode available on their newer generation anesthesia machines. Manufactures highly recommend APC during surgical procedures in which positioning or insufflation of the abdomen creates dramatic changes in pulmonary mechanics (e.g. laparoscopic, thoroscopic, prostatectomy).