Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2019
Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery: A Retrospective Cohort Study Using a Nationwide Database.
Routine preoperative echocardiography before operative repair of hip fracture does not reduce mortality or postoperative complcayions.
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Anesthesia and analgesia · Feb 2019
Emergency Department Airway Management Responsibilities in the United States.
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. ⋯ 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.
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Anesthesia and analgesia · Feb 2019
Discharge Hemoglobin Level and 30-Day Readmission Rates After Coronary Artery Bypass Surgery.
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). ⋯ A discharge Hb level below the institution mean for CABG patients does not provide evidence for an association with an increased 30-day readmission rate. In the small number of patients discharged with Hb <8 g/dL, there is a suggestion of increased risk for readmission and larger more controlled studies are needed to verify or refute this finding.
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Anesthesia and analgesia · Feb 2019
Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction: Part II: Adductor Canal Nerve Block-A Systematic Review and Meta-analysis.
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. ⋯ 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.
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Anesthesia and analgesia · Feb 2019
Organ Donation After Circulatory Death: Ethical Issues and International Practices.
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.