Anesthesia and analgesia
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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
Comparative Study Controlled Clinical TrialA comparison of ultrasound-guided and landmark-based approaches to saphenous nerve blockade: a prospective, controlled, blinded, crossover trial.
Blockade of the saphenous nerve is often used for surgeries below the knee. Depending on the approach, success rates vary widely ranging from 33% to 88%. In this prospective volunteer study, we compared 2 ultrasound-guided techniques, the modified vastus medialis and perifemoral saphenous nerve block with a below the knee field block. ⋯ In our prospective study, we have demonstrated that ultrasound-guided above the knee saphenous nerve blocks have higher success rates than a below the knee field block and are easily performed in a short amount of time.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled Trial Comparative StudyA comparative trial of the GlideScope(R) video laryngoscope to direct laryngoscope in children with difficult direct laryngoscopy and an evaluation of the effect of blade size.
GlideScope® video laryngoscope (GVL) has been proposed to be useful for airway management, but its efficacy for difficult airways has not been confirmed in pediatric patients. In this study, we evaluated the usefulness of the GVL for improving the laryngoscopic view in patients whose Cormack and Lehane grade (C&L grade) was ≥3 under direct laryngoscopy. We also assessed the effect of GVL blade size on the laryngoscopic view. ⋯ In patients with C&L grade ≥3 under direct laryngoscopy, GVLs significantly improved the laryngoscopic view when compared with DL or GVLw. The GVLs is recommended for improving the laryngoscopic view in patients with a difficult airway.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialPostoperative residual neuromuscular blockade is associated with impaired clinical recovery.
In this investigation, we sought to determine the association between objective evidence of residual neuromuscular blockade (train-of-four [TOF] ratio <0.9) and the type, incidence, and severity of subjective symptoms of muscle weakness in the postanesthesia care unit (PACU). ⋯ The incidence and severity of symptoms of muscle weakness were increased in the PACU in patients with a TOF <0.9.
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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.