Anesthesiology
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Biography Historical Article
Henry K. Beecher: the introduction of anesthesia into the university.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Cost-benefit and efficacy of aprotinin compared with epsilon-aminocaproic acid in patients having repeated cardiac operations: a randomized, blinded clinical trial.
Aprotinin and epsilon-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery. The marked difference in average wholesale cost between these two drug therapies (aprotinin, $1,080 vs. epsilon-aminocaproic acid, $11) has generated significant controversy regarding their relative efficacies and costs. ⋯ Aprotinin was more effective than epsilon-aminocaproic acid at decreasing bleeding and platelet transfusions. Epsilon-aminocaproic acid, however, was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery. A cost-benefit analysis using the lower cost of half-dose aprotinin ($540) still resulted in a significant cost advantage using epsilon-aminocaproic therapy (P = 0.022).
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia.
The authors compared patient-controlled interscalene analgesia (PCIA) with local anesthetics with intravenous patient-controlled analgesia (PCA) with opioids to manage postoperative pain after major shoulder surgery. ⋯ The use of the PCIA technique was uncomplicated and provided better pain relief than PCA during the first 18 h after operation. The incidence of side effects such as vomiting and pruritus was significantly decreased with the use of PCIA, and patient satisfaction was superior in the PCIA group.