Anesthesia and analgesia
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Anesthesia and analgesia · May 2014
Randomized Controlled Trial Comparative StudySedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair.
Low intraoperative Bispectral Index (BIS) values may be associated with increased mortality. In a previously reported trial to prevent delirium, we randomized patients undergoing hip fracture repair under spinal anesthesia to light (BIS >80) or deep (BIS approximately 50) sedation. We analyzed survival of patients in the original trial. ⋯ However, among patients with serious comorbidities (Charlson score >4), 1-year mortality was reduced in the light (22.2%) vs deep (43.6%) sedation group (hazard ratio [HR], 0.43; 95% confidence interval, 0.19-0.97; P = 0.04) during spinal anesthesia. Similarly, among patients with Charlson score >6, 1-year mortality was reduced in the light (28.6%) vs deep (52.6%) sedation group (HR 0.33; 95% confidence interval, 0.12-0.94; P = 0.04) during spinal anesthesia. Further research on reduced mortality after light sedation during spinal anesthesia is needed.
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Anesthesia and analgesia · May 2014
Comparative Study Observational StudyReduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.
Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. ⋯ Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.
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Anesthesia and analgesia · May 2014
Observational StudyThe Association Between ASA Status and Other Risk Stratification Models on Postoperative Intensive Care Unit Outcomes.
There is limited medical literature investigating the association between perioperative risk stratification methods and surgical intensive care unit (SICU) outcomes. Our hypothesis contends that routine assessments such as higher ASA physical status classification, surgical risk as defined by American College of Cardiology/American Heart Association guidelines, and simplified Revised Cardiac Index (SRCI) can reliably be associated with SICU outcomes. ⋯ Our study revealed that ASA physical status class is associated with increased SICU length of stay, mechanical ventilation, vasopressor treatment duration, NOD, readmission to ICU, and surgery risk is associated with NOD.