Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2013
ReviewFocused review: spinal anesthesia in severe preeclampsia.
Spinal anesthesia is widely regarded as a reasonable anesthetic option for cesarean delivery in severe preeclampsia, provided there is no indwelling epidural catheter or contraindication to neuraxial anesthesia. Compared with healthy parturients, those with severe preeclampsia experience less frequent, less severe spinal-induced hypotension. In severe preeclampsia, spinal anesthesia may cause a higher incidence of hypotension than epidural anesthesia; however, this hypotension is typically easily treated and short lived and has not been linked to clinically significant differences in outcomes. In this review, we describe the advantages and limitations of spinal anesthesia in the setting of severe preeclampsia and the evidence guiding intraoperative hemodynamic management.
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Anesthesia and analgesia · Sep 2013
ReviewStatistical grand rounds: a review of analysis and sample size calculation considerations for wilcoxon tests.
When a study uses an ordinal outcome measure with unknown differences in the anchors and a small range such as 4 or 7, use of the Wilcoxon rank sum test or the Wilcoxon signed rank test may be most appropriate. However, because nonparametric methods are at best indirect functions of standard measures of location such as means or medians, the choice of the most appropriate summary measure can be difficult. The issues underlying use of these tests are discussed. ⋯ These examples highlight the potential discordance between medians and Wilcoxon test results. Along with the issues surrounding the choice of a summary measure, there are considerations for the computation of sample size and power, confidence intervals, and multiple comparison adjustment. In addition, despite the increased robustness of the Wilcoxon procedures relative to parametric tests, some circumstances in which the Wilcoxon tests may perform poorly are noted, along with alternative versions of the procedures that correct for such limitations.
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Anesthesia and analgesia · Sep 2013
Case cancellation rates measured by surgical service differ whether based on the number of cases or the number of minutes cancelled.
Surgical cancellation rates typically are reported as the number of cancelled cases divided by the number of scheduled cases. However, the total number of cancelled minutes also has financial impact on surgeons' productivity. Cancellation rates can instead be calculated based on the number of minutes of cancelled cases. Hospitals typically benchmark cancellation rates, since not all cancellations are preventable (e.g., those due to new onset of patient symptoms requiring further workup and treatment before surgery can safely proceed). If the mean estimated duration of cancelled cases were the same as that of scheduled cases, rates would be equivalent whether calculated using the number of cancellations or the minutes of cancellations. It is unknown whether there is a difference between these 2 methods. ⋯ Calculating cancellation rates using case counts can inaccurately represent their impact on surgeon's productivity compared with using minutes of cancelled cases. Comparing numeric cancellation rates between hospitals or services without checking for bias may lead to inappropriate conclusions. We recommend that hospitals evaluate their data for potential bias to determine whether cancellation rates need to be calculated using scheduled minutes of cases rather than numbers of cancellations.