Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2015
The Association Between Sjögren Syndrome and Adverse Postoperative Outcomes: A Historical Cohort Study Using Administrative Health Data.
Sjögren syndrome is a chronic autoimmune disorder of the exocrine glands associated with cardiovascular events. We aimed to evaluate postoperative complications in patients with Sjögren syndrome undergoing noncardiac surgery. Specifically, we tested the primary hypothesis that patients with Sjögren syndrome have a greater risk of postoperative cardiovascular complications than those without the disease. Our secondary hypotheses were that patients with Sjögren syndrome are at greater risk of thromboembolic complications, microcirculatory complications, and mortality. ⋯ The presence of Sjögren syndrome does not place patients at an increased risk for postoperative complications or in-hospital mortality.
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Anesthesia and analgesia · Nov 2015
A Perioperative Evaluation of Respiratory Mechanics Using the Forced Oscillation Technique.
The forced oscillation technique is a new approach for assessing perioperative respiratory function. ⋯ The forced oscillation technique is a clinical tool that can be used to assess the effects of perioperative ventilation strategies on respiratory mechanics.
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Anesthesia and analgesia · Nov 2015
Observational StudyFailed Obstetric Spinal Anesthesia in a Nigerian Teaching Hospital: Incidence and Risk Factors.
In a retrospective survey, we found 1% cases with complete and partial failure of spinal anesthesia for cesarean delivery between 2008 and 2010, which we attributed to underreporting because of the study design. In this prospective study, we determined the incidence of failed spinal anesthesia and identified the factors that increased its risk. ⋯ The rate of failed spinal anesthesia from this study was high. The independent predictors of failure were multiple lumbar puncture attempts, use of the L4/L5 interspace, and the level of experience of the anesthesia provider. It is imperative to develop clear guidelines to standardize our obstetric spinal anesthetic practice as well as the management of failures.
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Anesthesia and analgesia · Nov 2015
Observational StudyLarge Heterogeneity in Mean Durations of Labor Analgesia Among Hospitals Reporting to the American Society of Anesthesiologists' Anesthesia Quality Institute.
Variability in the mean durations of labor analgesia for vaginal delivery among hospitals is unknown. Such differences in means among hospitals would influence appropriate equitable fee-for-service payment to US anesthesia groups. Equitable payment is the foundational principle of relative value unit payment, which, for anesthesia in the United States, means use of the American Society of Anesthesiologist's Relative Value Guide. ⋯ Our results show that the number of labor epidurals alone is not a valid measure to quantify obstetrical anesthesia productivity. In addition, payment to US anesthesia groups for labor analgesia based solely on the number of labor epidurals initiated is not equitable. Previous work showed lack of validity and equality of payment based on face-to-face time with the patient (i.e., like a surgical anesthetic). The use of base and time units, with one time unit per hour, is a suitable payment system.