Anesthesia and analgesia
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Anesthesia and analgesia · May 2014
ReviewThe effects of glucocorticoids on neuropathic pain: a review with emphasis on intrathecal methylprednisolone acetate delivery.
Methylprednisolone acetate (MPA) has a long history of use in the treatment of sciatic pain and other neuropathic pain syndromes. In several of these syndromes, MPA is administered in the epidural space. ⋯ In this review, we broadly consider mechanisms whereby glucocorticoids exert their action on spinal cascades relevant to the pain arising after nerve injury and inflammation. We then focus on the characteristics of the actions of MPA in pharmacokinetics, efficacy, and safety when administered in the intrathecal space.
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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.