Anesthesia and analgesia
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Anesthesia and analgesia · May 2014
Implementation of a total joint replacement-focused perioperative surgical home: a management case report.
The perioperative setting in the United States is noted for variable and fragmented care that increases the chance for errors and adverse outcomes as well as the overall cost of perioperative care. Recently, the American Society of Anesthesiologists put forward the Perioperative Surgical Home (PSH) concept as a potential solution to this problem. Although the PSH concept has been described previously, "real-life" implementation of this new model has not been reported. ⋯ We believe that our experience with the Total Joint Replacement PSH program provides solid evidence of the feasibility of this practice model to improve patient outcomes and achieve high patient satisfaction. In the future, the impact of LOS on cost will have to be better quantified. Specifically, future studies comparing PSH to traditional care will have to include consideration of postdischarge care, which are drivers of the perioperative costs.
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Anesthesia and analgesia · May 2014
Brain Tumors Enhance Plasmatic Coagulation: The Role of Hemeoxygenase-1.
Patients with brain tumors suffer significant thrombotic morbidity and mortality. In addition to increased thrombin generation via tumor release of tissue factor-bearing microparticles and hyperfibrinogenemia, brain tumors and surrounding normal brain likely generate endogenous carbon monoxide (CO) via the hemeoxygenase-1 (HO-1) system. CO has been shown to enhance plasmatic coagulation via formation of carboxyhemefibrinogen (COHF). Thus, our goals in this study were to determine whether patients with brain tumors had increased HO-1 upregulation/CO production, plasmatic hypercoagulability, and formation of COHF. ⋯ A subset of patients with brain tumors has increased endogenous CO production, plasmatic hypercoagulability, and COHF formation. Future investigation of the role played by HO-1 derived CO in the pathogenesis of brain tumor-associated thrombophilia is warranted.
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Anesthesia and analgesia · May 2014
Relative Influence on Total Cancelled Operating Room Time from Patients Who Are Inpatients or Outpatients Preoperatively.
In previous studies, hospitals' operating room (OR) schedules were influenced markedly by decisions made within a few days of surgery. At least half of ORs had their last case scheduled or changed within 2 working days of surgery. In the current investigation, we studied whether many of these changes were due to patients who were admitted before surgery. We differentiated these "inpatients" from "outpatients" having ambulatory surgery or admitted on the day of surgery. ⋯ Facilities can achieve a ≤2% cancellation rate for patients who are outpatient preoperatively with very few attending a preoperative clinic, when a virtual evaluation is carried out by phone. At least half of the cancelled time at health systems and hospitals is attributable to inpatients, and these patients principally are scheduled within 1 workday of the day of surgery. This is why there are so many changes to the OR schedule within 1 workday before the day of surgery. Hospitals should evaluate the cost-effectiveness of earlier assessments of inpatients. In addition, scheduling office decision-making within 1 workday before surgery should be based on statistical forecasts that include the risks of cancellation and of inpatient add-on cases being scheduled. Hospitals should monitor the performance of their perioperative managers with respect to such behavior.
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Anesthesia and analgesia · May 2014
Montelukast Attenuates Neuropathic Pain Through Inhibiting p38 Mitogen-Activated Protein Kinase and Nuclear Factor-Kappa B in a Rat Model of Chronic Constriction Injury.
Cysteinyl leukotrienes and their receptors have been shown to be involved in the generation of neuropathic pain. We performed this study to determine the antagonistic effect of montelukast, a cysteinyl leukotrienes receptor antagonist, on neuropathic pain and its underlying mechanism. ⋯ These results suggest that montelukast could effectively attenuate neuropathic pain in CCI rats by inhibiting the activation of p38MAPK and NF-κB signaling pathways in spinal microglia.