Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2011
Comparative StudyThe clinical value of routine chest radiographs in the first 24 hours after cardiac surgery.
Chest radiographs (CXRs) are obtained frequently in the intensive care unit (ICU). Whether these CXRs should be performed routinely or on clinical indication only is often debated. The aim of our study was to investigate the incidence and clinical significance of abnormalities found on routine postoperative CXRs in cardiac surgery patients and whether a restricted use of CXRs would influence the number of significant findings. ⋯ Partial elimination of routine CXRs in the first 24 hours after cardiac surgery seems possible for the majority of patients, but it is limited by the insensitivity of clinical assessment in predicting clinically important abnormalities detectable by CXRs.
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Anesthesia and analgesia · Jan 2011
Randomized Controlled Trial Comparative StudyIntraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery.
Patients undergoing complex spine surgery frequently experience severe pain in the postoperative period. The combined opiate receptor agonist/N-methyl-d-aspartate receptor antagonist methadone may be an optimal drug for these patients given the probable involvement of N-methyl-d-aspartate systems in the mechanism of opioid tolerance and hyperalgesia. ⋯ Perioperative treatment with a single bolus of methadone improves postoperative pain control for patients undergoing complex spine surgery.
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Anesthesia and analgesia · Jan 2011
Randomized Controlled Trial Comparative StudySurvey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests.
Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing and to identify strategies for reduction. ⋯ The percentage of patients with at least 1 unnecessary test is a suitable end point for monitoring providers' ordering. The incidence can be high despite efforts at improvement, but may be reduced if anesthesiologists rather than surgeons order presurgical tests and consults. However, anesthesia groups should be cognizant of potential heterogeneity among them based on time since training.
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Anesthesia and analgesia · Jan 2011
Comparative StudyIntraoperative thromboelastometry is associated with reduced transfusion prevalence in pediatric cardiac surgery.
The majority of pediatric cardiac surgery patients receive blood transfusions. We hypothesized that the routine use of intraoperative thromboelastometry to guide transfusion decisions would reduce the overall proportion of patients receiving transfusions in pediatric cardiac surgery. ⋯ The results suggest that routine use of intraoperative thromboelastometry in pediatric cardiac surgery to guide transfusions is associated with a reduced proportion of patients receiving transfusions and an altered transfusion pattern.
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Anesthesia and analgesia · Jan 2011
Comparative StudyPerioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery.
Although patients with sleep apnea (SA) are considered to be at increased risk for postoperative complications, evidence supporting increased risk of perioperative pulmonary morbidity is limited. The objective of this study, therefore, was to analyze perioperative demographics and pulmonary outcomes of patients with SA after orthopedic and general surgical procedures using a population-based sample. We hypothesized that SA is an independent risk factor for perioperative pulmonary complications, thus providing a basis for an increase in the utilization of resources, including intensive monitoring and development of strategies to prevent and treat these events. ⋯ SA is an independent risk factor for perioperative pulmonary complications. Our results may be used for hypothesis generation for clinical studies targeted to improve perioperative outcomes in this patient population.