Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2011
Comparative StudyAccurate classification of difficult intubation by computerized facial analysis.
Bedside airway evaluation is conduced before anesthesia, but all current methods perform modestly, with low sensitivity and positive predictive value. We hypothesized that subjective features of patients' anatomies improve anesthesiologists' ability to predict difficult intubation, and derived a computer model to do so, based on analysis of photographs of patients' faces. ⋯ Computerized analysis of facial structure and thyromental distance can classify easy versus difficult intubation with accuracy significantly outperforming popular clinical predictive tests.
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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
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 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.