Anesthesia and analgesia
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Anesthesia and analgesia · May 2014
Assessing the Accuracy of Common Pediatric Age-Based Weight Estimation Formulae.
Many of the common equations for weight estimation in children were either introduced before the widespread prevalence of childhood obesity or have not been assessed in overweight/obese children. Therefore, we assessed the accuracy of 3 common age-based weight estimation formulae (Advanced Pediatric Life Support, Luscombe, and Theron) for predicting the weight of children undergoing elective, noncardiac operations. We also developed and validated a new age-based weight estimation formula. ⋯ Accuracies of current weight estimation formulae varied greatly. Our derived equation (Michigan formula: weight (kg) = 3 x age (yr) + 10) demonstrated high accuracy when compared with existing formulae and may be more applicable for estimating the weight of contemporary American children.
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Anesthesia and analgesia · May 2014
ReviewStrategies for net cost reductions with the expanded role and expertise of anesthesiologists in the perioperative surgical home.
The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. ⋯ These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay.
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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.