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Anesthesia & Analgesia
Journal Prestige (SJR): 1.472
Citation Impact (citeScore): 3
Number of Followers: 176  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-2999 - ISSN (Online) 1526-7598
Published by LWW Wolters Kluwer Homepage  [307 journals]
  • A Questionable Return on Investment: Assessing The Cost of Preoperative
           Cardiac Testing
    • Authors: Nathan; Naveen
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Sad News for Length of Stay: The Impact of Anxiety and Depression
    • Authors: Wanderer; Jonathan P.; Nathan, Naveen
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Tuning Up the Life Saver: An Experimental Approach to Optimizing the
           Delivery of Intravenous Lipid Emulsions
    • Authors: Zeballos; José Luis; Strichartz, Gary R.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Does Following Perioperative Cardiovascular Evaluation Guidelines Increase
           Perioperative Costs'
    • Authors: Fleisher; Lee A.; Beckman, Joshua A.; Wijeysundera, Duminda N.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • The American Pediatric Critical Care Anesthesiologist: An Endangered
           Species Worth Saving
    • Authors: Yaster; Myron; Davis, Peter J.; Greeley, William J.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Preoperative Echocardiography in Hip Fracture Patients: A Waste of Time or
           Good Practice'
    • Authors: Memtsoudis; Stavros G.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Preoperative Echocardiography for Patients With Hip Fractures Undergoing
           Surgery: A Retrospective Cohort Study Using a Nationwide Database
    • Authors: Yonekura; Hiroshi; Ide, Kazuki; Onishi, Yoshika; Nahara, Isao; Takeda, Chikashi; Kawakami, Koji
      Abstract: imageBACKGROUND: The effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures.METHODS: Drawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission.RESULTS: Overall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83–1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72–1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses.CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee
           Surgery and Anterior Cruciate Ligament Reconstruction: Part II: Adductor
           Canal Nerve Blockā€”A Systematic Review and Meta-analysis
    • Authors: Sehmbi; Herman; Brull, Richard; Shah, Ushma Jitendra; El-Boghdadly, Kariem; Nguyen, David; Joshi, Girish P.; Abdallah, Faraj W.
      Abstract: imageBACKGROUND: Adductor canal block (ACB) has emerged as an effective analgesic regional technique for major knee surgeries in the last decade. Its motor-sparing properties make it particularly attractive for ambulatory knee surgery, but evidence supporting its use in ambulatory arthroscopic knee surgery is conflicting. This systematic review and meta-analysis evaluates the analgesic effects of ACB for ambulatory arthroscopic knee surgeries.METHODS: We conducted a comprehensive search of electronic databases for randomized controlled trials examining the analgesic effects of ACB compared to control or any other analgesic modality. Both minor arthroscopic and anterior cruciate ligament reconstruction (ACLR) surgeries were considered. Rest and dynamic pain scores, opioid consumption, opioid-related adverse effects, time to first analgesic request, patient satisfaction, quadriceps strength, and block-related complications were evaluated. Data were pooled using random-effects modeling.RESULTS: Our search yielded 10 randomized controlled trials comparing ACB with placebo or femoral nerve block (FNB); these were subgrouped according to the type of knee surgery. For minor knee arthroscopic surgery, ACB provided reduced postoperative resting pain scores by a mean difference (95% confidence interval) of −1.46 cm (−2.03 to −0.90) (P < .00001), −0.51 cm (−0.92 to −0.10) (P = .02), and −0.48 cm (−0.93 to −0.04) (P = .03) at 0, 6, and 8 hours, respectively, compared to control. Dynamic pain scores were reduced by a mean difference (95% confidence interval) of −1.50 cm (−2.10 to −0.90) (P < .00001), −0.50 cm (−0.95 to −0.04) (P = .03), and −0.59 cm (−1.12 to −0.05) (P = .03) at 0, 6, and 8 hours, respectively, compared to control. ACB also reduced the cumulative 24-hour oral morphine equivalent consumption by −7.41 mg (−14.75 to −0.08) (P = .05) compared to control. For ACLR surgery, ACB did not provide any analgesic benefits and did not improve any of the examined outcomes, compared to control. ACB was also not different from FNB for these outcomes.CONCLUSIONS: After minor ambulatory arthroscopic knee surgery, ACB provides modest analgesic benefits, including improved relief for rest pain, and reduced opioid consumption for up to 8 and 24 hours, respectively. The analgesic benefits of ACB are not different from placebo or FNB after ambulatory ACLR, suggesting a limited role of both blocks in this procedure. Paucity of trials dictates cautious interpretation of these findings. Future studies are needed to determine the role of ACB in the setting of local anesthetic instillation and/or graft donor-site analgesia.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Anticipated Rates and Costs of Guideline-Concordant Preoperative Stress
           Testing
    • Authors: Pappas; Matthew A.; Sessler, Daniel I.; Rothberg, Michael B.
      Abstract: imageBACKGROUND: Current guidelines recommend that patients have preoperative assessment of cardiac risk and functional status, and that patients at “elevated” cardiac risk with poor or unknown functional status be referred for preoperative stress testing. Little is known about current rates of testing or resultant medical costs. We set out to estimate the expected rates of preoperative stress testing and resultant costs if physicians in the United States were to follow current guidelines and to investigate differences that would arise from 2 risk prediction methods included in current guidelines.METHODS: We applied 2 risk prediction tools (Revised Cardiac Risk Index and Myocardial Infarction or Cardiac Arrest) included in current American College of Cardiology/American Heart Association guidelines to a multicenter prospective registry of patients undergoing surgery in the United States in 2009. We then calculated expected rates of preoperative cardiac stress testing if physicians were to follow American College of Cardiology/American Heart Association guidelines, expected nationwide direct medical expenditures that would result (in 2017 US dollars), and agreement beyond chance between the 2 risk prediction tools.RESULTS: Current guidelines recommend considerable spending on preoperative stress testing. Guideline-recommended spending would differ substantially depending on the risk prediction tool used and the reliability of the functional status assessment. Rates of testing and resultant spending are likely much greater among patients at “elevated” risk, compared with patients at “low” risk. Two guideline-recommended risk assessment tools, Revised Cardiac Risk Index and Myocardial Infarction or Cardiac Arrest, have poor agreement beyond chance across the currently recommended risk threshold.CONCLUSIONS: Preoperative stress testing is likely a considerable source of medical spending, despite unproven benefit. Which perioperative risk assessment tool clinicians should use, what risk thresholds are appropriate for patient selection, and the reliability of the functional status assessment all warrant further attention.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Relationship Between Preoperative Antidepressant and Antianxiety
           Medications and Postoperative Hospital Length of Stay
    • Authors: Vashishta; Rishi; Kendale, Samir M.
      Abstract: imageBACKGROUND: Patients on antidepressant or antianxiety medications often have complex perioperative courses due to difficult pain management, altered coping mechanisms, or medication-related issues. This study examined the relationship between preoperative antidepressants and antianxiety medications on postoperative hospital length of stay while controlling for confounding variables.METHODS: From an administrative database of 48,435 adult patients who underwent noncardiac surgery from 2011 to 2014 at a single, large urban academic institution, multivariable zero-truncated negative binomial regression analyses controlling for age, sex, medical comorbidities, and surgical type were performed to assess whether preoperative exposure to antidepressant or antianxiety medication use was associated with postoperative hospital length of stay.RESULTS: There were 5111 (10.5%) patients on antidepressants and 4912 (10.1%) patients on antianxiety medications. The median length of stay was 3 days (interquartile range = 2–6). After controlling for confounding variables, preoperative antidepressant medication was associated with increased length of stay with an incidence rate ratio of 1.04 (99% confidence interval, 1.0–1.08, P < .001) and antianxiety medication with an incidence rate ratio of 1.1 (99% confidence interval, 1.06–1.14; P < .001).CONCLUSIONS: The association between antidepressants or antianxiety medications and increased postoperative length of stay suggests that these patients may require greater attention in the perioperative period to hasten recovery, which may involve integrating preoperative counseling, postoperative psychiatric consults, or holistic recovery approaches into enhanced recovery protocols.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Comparative Regimens of Lipid Rescue From Bupivacaine-Induced Asystole in
           a Rat Model
    • Authors: Liu; Le; Jin, Zhousheng; Cai, Xixi; Xia, Yun; Zhang, Meiling; Papadimos, Thomas J.; Xu, Xuzhong; Shi, Kejian
      Abstract: imageBACKGROUND: It is currently unknown whether bupivacaine-induced asystole is better resuscitated with lipid emulsion (LE) administered peripherally or centrally, and whether different LE regimens administered peripherally demonstrated similar effects. In this study, we compared the effects of various regimens of lipid administration in a rat model of bupivacaine-induced asystole.METHODS: Forty-five adult male Sprague-Dawley rats were subjected to bupivacaine-induced asystole and randomly divided into 3 lipid regimens groups: (1) 20% LE was administered continuously via the internal jugular vein (CV-infusion group); (2) 20% LE was administered continuously via the tail vein (PV-infusion group); and (3) 20% LE was administered as divided boluses via the tail vein (PV-bolus group). The maximum dose of LE did not exceed 10 mL·kg−1. External chest compressions were administered until the return of spontaneous circulation (ROSC) or the end of a 40-minute resuscitation period.RESULTS: The survival rate, rate of ROSC, systolic blood pressure, heart rate, heart rate–blood pressure product, and coronary perfusion pressure during 2–40 minutes in the CV-infusion and PV-bolus groups were significantly higher than those in the PV-infusion group (P < .01), and the plasma total bupivacaine concentration and myocardial bupivacaine content were significantly lower (P < .05). Time to heartbeat return and time to ROSC in the CV-infusion and PV-bolus groups were significantly shorter than those in the PV-infusion group (P < .05).CONCLUSIONS: In the rat model of bupivacaine-induced asystole, a divided LE bolus regimen administered peripherally provided a better resuscitation outcome than that of a continuous LE infusion regimen peripherally, and performed in a similar fashion as the continuous LE infusion regimen administered centrally.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Electroencephalography and Brain Oxygenation Monitoring in the
           Perioperative Period
    • Authors: Scheeren; Thomas W. L.; Kuizenga, Merel H.; Maurer, Holger; Struys, Michel M. R. F.; Heringlake, Matthias
      Abstract: imageMaintaining brain function and integrity is a pivotal part of anesthesiological practice. The present overview aims to describe the current role of the 2 most frequently used monitoring methods for evaluation brain function in the perioperative period, ie, electroencephalography (EEG) and brain oxygenation monitoring. Available evidence suggests that EEG-derived parameters give additional information about depth of anesthesia for optimizing anesthetic titration. The effects on reduction of drug consumption or recovery time are heterogeneous, but most studies show a reduction of recovery times if anesthesia is titrated along processed EEG. It has been hypothesized that future EEG-derived indices will allow a better understanding of the neurophysiological principles of anesthetic-induced alteration of consciousness instead of the probabilistic approach most often used nowadays.Brain oxygenation can be either measured directly in brain parenchyma via a surgical burr hole, estimated from the venous outflow of the brain via a catheter in the jugular bulb, or assessed noninvasively by near-infrared spectroscopy. The latter method has increasingly been accepted clinically due to its ease of use and increasing evidence that near-infrared spectroscopy–derived cerebral oxygen saturation levels are associated with neurological and/or general perioperative complications and increased mortality. Furthermore, a goal-directed strategy aiming to avoid cerebral desaturations might help to reduce these complications. Recent evidence points out that this technology may additionally be used to assess autoregulation of cerebral blood flow and thereby help to titrate arterial blood pressure to the individual needs and for bedside diagnosis of disturbed autoregulation.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Organ Donation After Circulatory Death: Ethical Issues and International
           Practices
    • Authors: Jericho; Barbara G.
      Abstract: Donation after circulatory death (DCD) is an increasingly utilized practice that can contribute to reducing the difference between the supply of organs and the demand for organs for transplantation. As the number of transplanted organs from DCD donors continues to increase, there is an essential need to address the ethical aspects of DCD in institutional DCD protocols and clinical practice. Ethical issues of respecting the end-of-life wishes of a potential donor, respecting a recipient’s wishes, and addressing potential conflicts of interest are important considerations in developing policies and procedures for DCD programs. Although there may be diversity among DCD programs in Europe, Australia, Israel, China, the United States, and Canada, addressing ethical considerations in these DCD programs is essential to respect donors and recipients during the altruistic and generous act of organ donation.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Prophylactic Platelet Transfusions for Critically Ill Patients With
           Thrombocytopenia: A Single-Institution Propensity-Matched Cohort Study
    • Authors: Warner; Matthew A.; Chandran, Arun; Frank, Ryan D.; Kor, Daryl J.
      Abstract: imageBACKGROUND: Thrombocytopenia is frequently encountered in critically ill patients, often resulting in prophylactic transfusion of platelets for the prevention of bleeding complications. However, the efficacy of this practice remains unclear. The objective of this study was to determine the relationship between prophylactic platelet transfusion and bleeding complications in critically ill patients.METHODS: This is a retrospective cohort study of adults admitted to surgical, medical, or combined medical-surgical intensive care units (ICUs) at a single academic institution between January 1, 2009, and December 31, 2013. Inclusion criteria included age ≥18 years and a platelet count measured during ICU admission. Propensity-matched analyses were used to evaluate associations between prophylactic platelet transfusions and the outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of ICU and hospital-free days and changes in sequential organ failure assessment scores.RESULTS: A total of 40,693 patients were included in the investigation with 3227 (7.9%) receiving a platelet transfusion and 1065 (33.0%) for which platelet transfusion was prophylactic in nature. In propensity-matched analyses, 994 patients with prophylactic platelet transfusion were matched to those without a transfusion. Patients receiving prophylactic platelets had significantly higher red blood cell transfusion rates (odds ratio 7.5 [5.9–9.5]; P < .001), fewer ICU-free days (mean [standard deviation] 20.8 [9.1] vs 22.7 [8.3] days; P = .004), fewer hospital-free days (13.0 [9.7] vs 15.8 [9.4] days; P < .001), and less improvement in sequential organ failure assessment scores (mean decrease of 0.2 [3.6] vs 1.8 [3.3]; P < .001) in the subsequent 24 hours. These findings appeared robust, persisting in multiple predefined sensitivity analyses.CONCLUSIONS: Prophylactic administration of platelets in the critically ill was not associated with improved clinical outcomes, though residual confounding may exist. Further investigation of platelet transfusion strategies in this population is warranted.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Emergency Department Airway Management Responsibilities in the United
           States
    • Authors: Chiaghana; Chukwudi; Giordano, Christopher; Cobb, Danielle; Vasilopoulos, Terrie; Tighe, Patrick J.; Sappenfield, Joshua W.
      Abstract: imageBACKGROUND: In the 1990s, emergency medicine (EM) physicians were responsible for intubating about half of the patients requiring airway management in emergency rooms. Since then, no studies have characterized the airway management responsibilities in the emergency room.METHODS: A survey was sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, whether an anesthesiologist was available “in-house” 24 hours a day, and whether there was a protocol for anesthesiologists to assist as backup during intubations. Responses were collected, reviewed, linked by city, and mapped using Python.RESULTS: The majority of the responses came from the Eastern Association for Surgery of Trauma (84.6%). Of the respondents, 72.6% were from level-1 trauma centers, and most were located in the eastern half of the United States. In the emergency room, EM physicians were primarily responsible for intubations at 81% of the surveyed institutions. In trauma bays, EM physicians were primarily responsible for 61.4% of intubations. There did not appear to be a geographical pattern for personnel responsible for managing the airway at the institutions surveyed.CONCLUSIONS: The majority of institutions have EM physicians managing their airways in both emergency rooms and trauma bays. This may support the observations of an increased percentage of airway management in the emergency room and trauma bay setting by EM physicians compared to 20 years ago.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Combined Colloid Preload and Crystalloid Coload Versus Crystalloid Coload
           During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled
           Trial
    • Authors: Tawfik; Mohamed Mohamed; Tarbay, Amany Ismail; Elaidy, Ahmed Mohamed; Awad, Karim Ali; Ezz, Hanaa Mohamed; Tolba, Mohamed Ahmed
      Abstract: imageBACKGROUND: The optimal strategy of fluid administration during spinal anesthesia for cesarean delivery is still unclear. Ultrasonography of the inferior vena cava (IVC) has been recently used to assess the volume status and predict fluid responsiveness. In this double-blind, randomized controlled study, we compared maternal hemodynamics using a combination of 500-mL colloid preload and 500-mL crystalloid coload versus 1000-mL crystalloid coload. We assessed the IVC at baseline and at subsequent time points after spinal anesthesia.METHODS: Two hundred American Society of Anesthesiologists physical status II parturients with full-term singleton pregnancies scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either 500-mL colloid preload followed by 500-mL crystalloid coload (combination group) or 1000-mL crystalloid coload (crystalloid coload group) administered using a pressurizer. Ephedrine 3, 5, and 10 mg boluses were administered when the systolic blood pressure decreased below 90%, 80% (hypotension), and 70% (severe hypotension) of the baseline value, respectively. The IVC was assessed using the subcostal long-axis view at baseline, at 1 and 5 minutes after intrathecal injection, and immediately after delivery; the maximum and minimum IVC diameters were measured, and the IVC collapsibility index (CI) was calculated using the formula: IVC-CI = (maximum IVC diameter – minimum IVC diameter)/maximum IVC diameter. The primary outcome was the total ephedrine dose.RESULTS: Data from 198 patients (99 patients in each group) were analyzed. The median (range) of the total ephedrine dose was 11 (0–60) mg in the combination group and 13 (0–61) mg in the crystalloid coload group; the median of the difference (95% nonparametric confidence interval) was −2 (−5 to 0.00005) mg, P = .22. There were no significant differences between the 2 groups in the number of patients requiring ephedrine, the incidence of hypotension and severe hypotension, the time to the first ephedrine dose, and neonatal Apgar scores at 1 and 5 minutes. The maximum and minimum IVC diameters in each group increased after spinal anesthesia and after delivery, and they were larger in the combination group. The IVC-CI after delivery was higher in the crystalloid coload group.CONCLUSIONS: The combination of 500-mL colloid preload and 500-mL crystalloid coload did not reduce the total ephedrine dose or improve other maternal outcomes compared with 1000-mL crystalloid coload. The IVC was reliably viewed before and during cesarean delivery, and its diameters significantly changed over time and differed between the 2 groups.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Perioperative Management and In-Hospital Outcomes After Minimally Invasive
           Repair of Pectus Excavatum: A Multicenter Registry Report From the Society
           for Pediatric Anesthesia Improvement Network
    • Authors: Muhly; Wallis T.; Beltran, Ralph J.; Bielsky, Alan; Bryskin, Robert B.; Chinn, Christopher; Choudhry, Dinesh K.; Cucchiaro, Giovanni; Fernandez, Allison; Glover, Chris D.; Haile, Dawit T.; Kost-Byerly, Sabine; Schnepper, Gregory D.; Zurakowski, David; Agarwal, Rita; Bhalla, Tarun; Eisdorfer, Seth; Huang, Henry; Maxwell, Lynne G.; Thomas, James J.; Tjia, Imelda; Wilder, Robert T.; Cravero, Joseph P.
      Abstract: imageBACKGROUND: There are few comparative data on the analgesic options used to manage patients undergoing minimally invasive repair of pectus excavatum (MIRPE). The Society for Pediatric Anesthesia Improvement Network was established to investigate outcomes for procedures where there is significant management variability. For our first study, we established a multicenter observational database to characterize the analgesic strategies used to manage pediatric patients undergoing MIRPE. Outcome data from the participating centers were used to assess the association between analgesic strategy and pain outcomes.METHODS: Fourteen institutions enrolled patients from June 2014 through August 2015. Network members agreed to an observational methodology where each institution managed patients based on their institutional standards and protocols. There was no requirement to standardize care. Patients were categorized based on analgesic strategy: epidural catheter (EC), paravertebral catheter (PVC), wound catheter (WC), no regional (NR) analgesia, and intrathecal morphine techniques. Primary outcomes, pain score and opioid consumption by postoperative day (POD), for each technique were compared while adjusting for confounders using multivariable modeling that included 5 covariates: age, sex, number of bars, Haller index, and use of preoperative pain medication. Pain scores were analyzed using repeated-measures analysis of variance with Bonferroni correction. Opioid consumption was analyzed using a multivariable quantile regression.RESULTS: Data were collected on 348 patients and categorized based on primary analgesic strategy: EC (122), PVC (57), WC (41), NR (120), and intrathecal morphine (8). Compared to EC, daily median pain scores were higher in patients managed with PVC (POD 0), WC (POD 0, 1, 2, 3), and NR (POD 0, 1, 2), respectively (P < .001–.024 depending on group). Daily opioid requirements were higher in patients managed with PVC (POD 0, 1), WC (POD 0, 1, 2), and NR (POD 0, 1, 2) when compared to patients managed with EC (P < .001).CONCLUSIONS: Our data indicate variation in pain management strategies for patients undergoing MIRPE within our network. The results indicate that most patients have mild-to-moderate pain postoperatively regardless of analgesic management. Patients managed with EC had lower pain scores and opioid consumption in the early recovery period compared to other treatment strategies.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Building a Bridge Between Pediatric Anesthesiologists and Pediatric
           Intensive Care
    • Authors: Longacre; Mckenna M.; Cummings, Brian M.; Bader, Angela M.
      Abstract: imageDespite the aligned histories, development, and contemporary practices, today, pediatric anesthesiologists are largely absent from pediatric intensive care units. Contributing to this divide are deficits in exposure to pediatric intensive care at all levels of training in anesthesia and significant credentialing barriers. These observations have led us to consider, does the current structure of training lead to the ability to optimally innovate and collaborate in the delivery of pediatric critical care? We consider how redesigning the pediatric critical care training pathway available for pediatric anesthesiologists may improve care of children both in and out of the operating room by facilitating further sharing of skills, research, and clinical experience. To do so, we review the nuances of both training tracts and the potential benefits and challenges of facilitating greater integration of these aligned fields.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Emergency Manual Implementation in a Large Academic Anesthesia Practice:
           Strategy and Improvement in Performance on Critical Steps
    • Authors: Gleich; Stephen J.; Pearson, Amy C. S.; Lindeen, Kevin C.; Hofer, Ryan E.; Gilkey, George D.; Borst, Luann F.; Haile, Dawit T.; Martin, David P.
      Abstract: imageBACKGROUND: The use of cognitive aids, such as emergency manuals (EMs), improves team performance on critical steps during crisis events. In our large academic anesthesia practice, we sought to broadly implement an EM and subsequently evaluate team member performance on critical steps.METHODS: We observed the phases of implementing an EM at a large academic anesthesia practice from 2013 to 2016, including the formation of the EM implementation team, identification of preferred EM characteristics, consideration of institution-specific factors, selection of the preferred EM, recognition of logistical barriers, and staff education. Utilization of the EM was tested in a regular clinical environment with all available resources using a standardized verbal simulation of 3 crisis events both preimplementation and 6 months postimplementation. Individual members of the anesthesia team were asked to verbalize interventions for specific crisis events over 60 seconds.RESULTS: We introduced a customized version of the Stanford Emergency Manual on January 26, 2015. Fifty-nine total participants (equal proportion of anesthesiology attending physicians, resident physicians, certified registered nurse anesthetists, and student registered nurse anesthetist staff) were surveyed in the preimplementation phase and 60 in the 6-month postimplementation phase. In the postimplementation phase, a minority (41.7%) utilized the EM for the verbal-simulated crisis events. Those who used the EM performed better than those who did not (median 21.0 critical steps out of a possible 30 total steps [70.0%], interquartile range 19–25 vs 18.0 critical steps verbalized [60.0%], interquartile range 16–20; P < .001). Among all subjects, the median number of critical steps verbalized was 16 (53.3%) preimplementation and 19.5 critical steps (65.0%) postimplementation.CONCLUSIONS: Implementation of an EM in a large academic anesthesia practice is not without challenges. While full integration of the EM was not achieved 6 months after implementation, verbalization of critical steps on 3 simulated crisis events improved when the EM was utilized.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Discharge Hemoglobin Level and 30-Day Readmission Rates After Coronary
           Artery Bypass Surgery
    • Authors: Cho; Brian C.; DeMario, Vincent M.; Grant, Michael C.; Hensley, Nadia B.; Brown, Charles H. IV; Hebbar, Sachidanand; Mandal, Kaushik; Whitman, Glenn J.; Frank, Steven M.
      Abstract: imageBACKGROUND: Restrictive transfusion strategies supported by large randomized trials are resulting in decreased blood utilization in cardiac surgery. What remains to be determined, however, is the impact of lower discharge hemoglobin (Hb) levels on readmission rates. We assessed patients with higher versus lower Hb levels on discharge to compare 30-day readmission rates after coronary artery bypass grafting (CABG).METHODS: We retrospectively evaluated 1552 patients undergoing isolated CABG at our institution from January 2013 to May 2016. We evaluated 2 Hb cohorts: “high” (above) and “low” (below) the mean discharge Hb level of 9.4 g/dL, comparing patient characteristics, blood utilization, and clinical outcomes including 30-day readmission rates. We further evaluated the effects of the lowest (12 g/dL), “mild anemia” (10–11.9 g/dL), “moderate anemia” (8–9.9 g/dL), and “severe anemia” (
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Preoperative Salivary Cortisol AM/PM Ratio Predicts Early Postoperative
           Cognitive Dysfunction After Noncardiac Surgery in Elderly Patients
    • Authors: Han; Yuan; Han, Liu; Dong, Meng-Meng; Sun, Qing-Chun; Zhang, Zhen-Feng; Ding, Ke; Zhang, Yao-Dong; Mannan, Abdul; Xu, Yi-Fan; Ou-Yang, Chang-Li; Li, Zhi-Yong; Gao, Can; Cao, Jun-Li
      Abstract: imageBACKGROUND: The diagnosis of postoperative cognitive dysfunction (POCD) requires complicated neuropsychological testing and is often delayed. Possible biomarkers for early detection or prediction are essential for the prevention and treatment of POCD. Preoperative screening of salivary cortisol levels may help to identify patients at elevated risk for POCD.METHODS: One hundred twenty patients>60 years of age and undergoing major noncardiac surgery underwent neuropsychological testing 1 day before and 1 week after surgery. Saliva samples were collected in the morning and the evening 1 day before surgery. POCD was defined as a Z-score of ≤−1.96 on at least 2 different tests. The primary outcome was the presence of POCD. The primary objective of this study was to assess the relationship between the ratio of AM (morning) to PM (evening) salivary cortisol levels and the presence of POCD. The secondary objective was to assess the relationship between POCD and salivary cortisol absolute values in the morning or in the evening.RESULTS: POCD was observed in 17.02% (16 of 94; 95% confidence interval [CI], 9.28%–24.76%) of patients 1 week after the operation. A higher preoperative AM/PM salivary cortisol ratio predicted early POCD onset (odds ratio [OR], 1.56; 95% CI, 1.20–2.02; P = .001), even after adjusting for the Mini-Mental Sate Examination score (odds ratio, 1.55; 95% CI, 1.19–2.02; P = .001). The area under the receiver operating characteristic curve for the salivary cortisol AM/PM ratio in individuals with POCD was 0.72 (95% CI, 0.56–0.88; P = .006). The optimal cutoff value was 5.69, with a sensitivity of 50% and specificity of 91%.CONCLUSIONS: The preoperative salivary cortisol AM/PM ratio was significantly associated with the presence of early POCD. This biomarker may have potential utility for screening patients for an increased risk and also for further elucidating the etiology of POCD.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Opioid Oversupply After Joint and Spine Surgery: A Prospective Cohort
           Study
    • Authors: Bicket; Mark C.; White, Elizabeth; Pronovost, Peter J.; Wu, Christopher L.; Yaster, Myron; Alexander, G. Caleb
      Abstract: imageBACKGROUND: Many patients receive prescription opioids at hospital discharge after surgery, yet little is known regarding how often these opioids go unused. We estimated the prevalence of unused opioids, use of nonopioid analgesics, and storage and disposal practices after same-day and inpatient surgery.METHODS: In this prospective cohort study at a large, inner-city tertiary care hospital, we recruited individuals ≥18 years of age undergoing elective same-day or inpatient joint and spine surgery from August to November 2016. Using patient surveys via telephone calls, we assessed patient-reported outcomes at 2-day, 2-week, 1-month, and 6-month intervals, including: (1) stopping opioid treatment and in possession of unused opioid pills (primary outcome), (2) number of unused opioid tablets reported after stopping opioids, (3) use of nonopioid pain treatments, and (4) knowledge and practice regarding safe opioid storage and disposal.RESULTS: Of 141 eligible patients, 140 (99%) consented (35% taking preoperative opioids; mean age 56 years [standard deviation 16 years]; 47% women). One- and 6-month follow-up was achieved for 115 (82%) and 110 patients (80%), respectively. Among patients who stopped opioid therapy, possession of unused opioids was reported by 73% (95% confidence intervals, 62%–82%) at 1-month follow-up and 34% (confidence interval, 24%–45%) at 6-month follow-up. At 1 month, 46% had ≥20 unused pills, 37% had ≥200 morphine milligram equivalents, and only 6% reported using multiple nonopioid adjuncts. Many patients reported unsafe storage and failure to dispose of opioids at both 1-month (91% and 96%, respectively) and 6-month (92% and 47%, respectively) follow-up.CONCLUSIONS: After joint and spine surgery, many patients reported unused opioids, infrequent use of analgesic alternatives, and lack of knowledge regarding safe opioid storage and disposal. Interventions are needed to better tailor postoperative analgesia and improve the safe storage and disposal of prescription opioids.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Pharmacological Characterization of Levorphanol, a G-Protein Biased Opioid
           Analgesic
    • Authors: Le Rouzic; Valerie; Narayan, Ankita; Hunkle, Amanda; Marrone, Gina F.; Lu, Zhigang; Majumdar, Susruta; Xu, Jin; Pan, Ying-Xian; Pasternak, Gavril W.
      Abstract: imageBACKGROUND: Levorphanol is a potent analgesic that has been used for decades. Most commonly used for acute and cancer pain, it also is effective against neuropathic pain. The recent appreciation of the importance of functional bias and the uncovering of multiple µ opioid receptor splice variants may help explain the variability of patient responses to different opioid drugs.METHODS: Here, we evaluate levorphanol in a variety of traditional in vitro receptor binding and functional assays. In vivo analgesia studies using the radiant heat tail flick assay explored the receptor selectivity of the responses through the use of knockout (KO) mice, selective antagonists, and viral rescue approaches.RESULTS: Receptor binding studies revealed high levorphanol affinity for all the μ, δ, and κ opioid receptors. In 35S-GTPγS binding assays, it was a full agonist at most µ receptor subtypes, with the exception of MOR-1O, but displayed little activity in β-arrestin2 recruitment assays, indicating a preference for G-protein transduction mechanisms. A KO mouse and selective antagonists confirmed that levorphanol analgesia was mediated through classical µ receptors, but there was a contribution from 6 transmembrane targets, as illustrated by a lower response in an exon 11 KO mouse and its rescue with a virally transfected 6 transmembrane receptor splice variant. Compared to morphine, levorphanol had less respiratory depression at equianalgesic doses.CONCLUSIONS: While levorphanol shares many of the same properties as the classic opioid morphine, it displays subtle differences that may prove helpful in its clinical use. Its G-protein signaling bias is consistent with its diminished respiratory depression, while its incomplete cross tolerance with morphine suggests it may prove valuable clinically with opioid rotation.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Statistical Process Control: No Hits, No Runs, No Errors'
    • Authors: Vetter; Thomas R.; Morrice, Douglas
      Abstract: imageA novel intervention or new clinical program must achieve and sustain its operational and clinical goals. To demonstrate successfully optimizing health care value, providers and other stakeholders must longitudinally measure and report these tracked relevant associated outcomes. This includes clinicians and perioperative health services researchers who chose to participate in these process improvement and quality improvement efforts (“play in this space”). Statistical process control is a branch of statistics that combines rigorous sequential, time-based analysis methods with graphical presentation of performance and quality data. Statistical process control and its primary tool—the control chart—provide researchers and practitioners with a method of better understanding and communicating data from health care performance and quality improvement efforts. Statistical process control presents performance and quality data in a format that is typically more understandable to practicing clinicians, administrators, and health care decision makers and often more readily generates actionable insights and conclusions. Health care quality improvement is predicated on statistical process control. Undertaking, achieving, and reporting continuous quality improvement in anesthesiology, critical care, perioperative medicine, and acute and chronic pain management all fundamentally rely on applying statistical process control methods and tools. Thus, the present basic statistical tutorial focuses on the germane topic of statistical process control, including random (common) causes of variation versus assignable (special) causes of variation: Six Sigma versus Lean versus Lean Six Sigma, levels of quality management, run chart, control charts, selecting the applicable type of control chart, and analyzing a control chart. Specific attention is focused on quasi-experimental study designs, which are particularly applicable to process improvement and quality improvement efforts.
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • A Global Anesthesia Training Framework
    • Authors: Morriss; Wayne; Ottaway, Andrew; Milenovic, Miodrag; Gore-Booth, Julian; Haylock-Loor, Carolina; Onajin-Obembe, Bisola; Barreiro, Gonzalo; Mellin-Olsen, Jannicke
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Smith’s Anesthesia for Infants and Children, 9th ed
    • Authors: Walker; Scott G.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Essentials of Anesthesia for Infants and Neonates
    • Authors: Mannion; Stephen; O’Sullivan, Michael
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Essentials of Trauma Anesthesia, 2nd ed
    • Authors: Chima; Navraj S.; Duggan, Laura V.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Anesthesiology: A Practical Approach
    • Authors: Adler; Adam C.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Handbook of Sepsis
    • Authors: Trivedi; Vatsal; Lalu, Manoj M.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In-Flight Medical Emergencies: A Practical Guide to Preparedness and
           Response
    • Authors: Payen; Didier
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Free to Learn: Why Unleashing the Instinct to Play Will Make Our Children
           Happier, More Self-Reliant, and Better Students for Life
    • Authors: Gupta; Deepak
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Pain Management: A Problem-Based Learning Approach
    • Authors: Cheung; Chi Wai; Irwin, Michael Garnet
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • A Time-Release History of the Opioid Epidemic
    • Authors: McCormick; Patrick J.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Trainability of Application of the Correct Cricoid Force: Time to Rely on
           Devices'
    • Authors: Salem; M. Ramez; Khorasani, Arjang; Al-Zaher, Zaki; Bamadhaj, Munir; Zeidan, Ahed
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Noll; Eric; Bennett-Guerrero, Elliott
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Do We Need Specific Certification to Use Anesthesia Information Management
           Systems'
    • Authors: Bignami; Elena; Bellini, Valentina
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Simpao; Allan F.; Rehman, Mohamed A.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Hofer; Ira S.; Levin, Matthew A.; Simpao, Allan F.; McCormick, Patrick J.; Rothman, Brian
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In Response to Afreen Et Al
    • Authors: White; Jeffrey D.; Bursian, Alberto; Gravenstein, Nikolaus; Draganov, Peter V.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Phillips; Mark C.; Ness, Timothy J.; Bryant, Ayesha S.
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Noninvasive Continuous Blood Pressure Monitoring: Are the Intraoperative
           Episodes of Hypotension in Clear Sight'
    • Authors: Lakhal; Karim
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Maheshwari; Kamal; Makarova, Natalya; Sessler, Daniel I.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Clockwise Versus Counterclockwise Rotation of Endotracheal Tube When Using
           Videolaryngoscopy in Children
    • Authors: Lai; Yu Yung; Chang, Chia Ming
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Is Postoperative Hypotension a Risk Factor for Surgical Site Infections
           After Colorectal Surgery'
    • Authors: Liu; Yan-chen; Meng, Xiao-Yan; Xu, Shuai
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • In Response
    • Authors: Makarova; Natalya; Yilmaz, Huseyin O.; Mascha, Edward J.; Sessler, Daniel I.; Turan, Alparslan
      Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
  • Laryngeal Mask Airway Versus Other Airway Devices for Anesthesia in
           Children With an Upper Respiratory Tract Infection: A Systematic Review
           and Meta-analysis of Respiratory Complications: Erratum
    • Abstract: No abstract available
      PubDate: Fri, 01 Feb 2019 00:00:00 GMT-
       
 
 
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