Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
ReviewBrief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.
In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. ⋯ The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.
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Anesthesia and analgesia · Jul 2013
Multicenter StudyValue of a scheduled duration quantified in terms of equivalent numbers of historical cases.
Probabilistic estimates of case duration are important for several decisions on and soon before the day of surgery, including filling or preventing a hole in the operating room schedule, and comparing the durations of cases between operating rooms with and without use of specialized equipment to prevent resource conflicts. Bayesian methods use a weighted combination of the surgeon's estimated operating room time and historical data as a prediction for the median duration of the next case of the same combination. Process variability around that prediction (i.e., the coefficient of variation) is estimated using data from similar procedures. A Bayesian method relies on a parameter, τ, that specifies the equivalence between the scheduled estimate and the information contained in the median of a certain number of historical data. ⋯ Understanding performance of Bayesian methods for case duration is important because variability in durations has a large influence on appropriate management decisions the working day before and on the day of surgery. Both scheduled durations and historical data need to be used for these decisions. What matters is not the choice of τ but quantifying the variability using the Bayesian method and using it in managerial decisions.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialLateral parasagittal versus midline interlaminar lumbar epidural steroid injection for management of low back pain with lumbosacral radicular pain: a double-blind, randomized study.
Epidural steroid injections are commonly used for management of low back pain with lumbosacral radicular pain and can be administered by either interlaminar or transforaminal routes. The transforaminal route is reported to be more effective than the interlaminar route due to higher delivery of drug at the ventral epidural space. However, the transforaminal route has been associated with serious complications including spinal cord injury and permanent paralysis. Hence, there is a search for a technically better route with fewer complications for drug delivery into the ventral epidural space. Recently, a parasagittal interlaminar (PIL) approach of epidural contrast injection was reported to have 100% ventral epidural spread. However, the therapeutic efficacy of this route has never been investigated. We compared the therapeutic efficacy of the PIL approach and midline interlaminar (MIL) approach. We hypothesized that the PIL approach may produce a better clinical outcome because of better ventral epidural spread of the drug compared with MIL approach. ⋯ Epidural steroid injection administered with the PIL approach was significantly more effective for pain relief and improvement in disability than the MIL approach for 6 months in the management of low back pain with lumbosacral radicular pain.
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Anesthesia and analgesia · Jul 2013
The effect of full expiration on the position and size of the subclavian vein in spontaneously breathing adults.
If full expiration during subclavian venous cannulation increases the distance between the subclavian vein (SCV) and the pleura or increases the diameter of the vein, it might decrease the incidence of pneumothorax and/or increase the success rate of venous cannulation. In this study, we evaluated the effect of full expiration on the distance from the SCV to the pleura and on the crosssectional area (CSA) of the SCV in spontaneously breathing adults. ⋯ The distance from the SCV to the pleura did not change after full expiration. However, this simple technique can still be considered during placement of subclavian catheters in spontaneously breathing patients, because it significantly enlarges the CSA of the SCV.
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Anesthesia and analgesia · Jul 2013
Editorial Comment"Never" events: anesthesiology's dirty little secret.