Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2015
The relationship between competition and quality in procedural cardiac care.
Anesthesiologists are frequently involved in efforts to meet perioperative quality metrics. The degree to which hospitals compete on publicly reported quality measures, however, is unclear. We hypothesized that hospitals in more competitive environments would be more likely to compete on quality and thus perform better on such measures. To test our hypothesis, we studied the relationship between competition and quality in hospitals providing procedural cardiac care and participating in a national quality database. ⋯ An analysis of the Hospital Compare database found that competition among hospitals correlated overall with increased Medicare costs but did not predict better scores on publicly reported quality metrics. Our results suggest that hospitals do not compete meaningfully on publicly reported quality metrics or costs.
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Anesthesia and analgesia · Jan 2015
Review Meta Analysis Comparative StudyHyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery.
There is limited evidence supporting superiority between plain or hyperbaric spinal bupivacaine for spinal cesarean section.
pearl -
Anesthesia and analgesia · Jan 2015
Multicenter Study Clinical TrialPsychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials.
Elective surgery can itself precipitate post-traumatic stress disorder even in the absence of intra-operative awareness.
pearl -
Anesthesia and analgesia · Jan 2015
ReviewMetrology in medicine: from measurements to decision, with specific reference to anesthesia and intensive care.
Metrology is the science of measurements. Although of critical importance in medicine and especially in critical care, frequent confusion in terms and definitions impact either interphysician communications or understanding of manufacturers' and engineers' instructions and limitations when using devices. In this review, we first list the terms defined by the International Bureau of Weights and Measures regarding quantities and units, measurements, devices for measurement, properties of measuring devices, and measurement standards. The traditional tools for assessing the most important measurement quality criteria are also reviewed with clinical examples for diagnosis, alarm, and titration purposes, as well as for assessing the uncertainty of reference methods.
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Anesthesia and analgesia · Jan 2015
Randomized Controlled TrialBlood/Gas Partition Coefficients for Isoflurane, Sevoflurane, and Desflurane in a Clinically Relevant Patient Population.
The blood/gas partition coefficient of a certain volatile anesthetic is of clinical importance because it determines its velocity of uptake into and elimination from the body of a patient and thus its pharmacokinetic behavior. To date, the blood/gas partition coefficients of isoflurane, sevoflurane, and desflurane have been measured in small numbers of subjects or in particular study groups, for example, healthy volunteers, patients experiencing a common kind of disease, or mothers immediately after giving birth. The objective of this study was to determine the blood/gas partition coefficients of these volatile anesthetics at 37°C in a larger clinically relevant and adult patient population. Furthermore, we tested whether age, gender, body mass index, hemoglobin concentration, or hematocrit had an influence on the coefficients. ⋯ The blood/gas partition coefficients of the modern volatile anesthetics, in particular, those of sevoflurane and desflurane, may be higher than that has been hitherto reported. Therefore, their uptake and elimination may occur more slowly in some patients than has been supposed. The blood/gas partition coefficients of isoflurane, sevoflurane, and desflurane measured in this study appear to be representative because they were determined in a clinically and numerically relevant patient cohort.