Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2015
Historical ArticleMedical and ethical challenges during the first successful human kidney transplantation in 1954 at peter bent brigham hospital, Boston.
The first successful major organ transplantation, a kidney transplant, took place on December 23, 1954, at Peter Bent Brigham Hospital, Boston, Massachusetts. This was the beginning of major organ transplants commonly performed today, heralding one of the most significant achievements of medicine. A half-century later, heart, liver, limb, and even face transplants have become standard practice. In this report, we explore details of the preparations, the ethical dilemmas and the unknowns, and how these issues were addressed and overcome. ⋯ Medical and ethical challenges dominated the scene of the first successful major organ transplant, which began the remarkable advance in transplant medicine, an advance that occurred very rapidly between 1947 and 1951.
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Anesthesia and analgesia · Jan 2015
Observational StudyBlinded Observer Evaluation of Distal Skin Temperature for Predicting Lateral Infraclavicular Block Success.
Changes in digit skin temperature may be used to predict and determine upper limb nerve block success. We investigated whether a temperature difference between the blocked and the nonblocked hands, simply registered by touching the skin of the 5th and 2nd digit was valid and reliable as a diagnostic test for predicting a successful lateral infraclavicular block. ⋯ We found that a qualitative difference in skin temperature between the blocked and nonblocked hands, measured distally on the 2nd and 5th digits, was a valid and reliable diagnostic test for predicting successful lateral infraclavicular block.
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Anesthesia and analgesia · Jan 2015
ReviewAnesthetic management of patients undergoing intracranial bypass procedures.
Cerebral revascularization is used to augment or replace cerebral blood flow in patients at risk of developing cerebral ischemia. These include patients with moyamoya disease, occlusive cerebrovascular disease, skull base tumors, and complex aneurysms. ⋯ The anesthetic concerns for most patients presenting for different types of bypass procedures are similar and include the maintenance of adequate cerebral perfusion to prevent cerebral ischemia. Patients with complex aneurysms and tumors have additional considerations related to the surgical treatment of the underlying pathology.
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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
Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty.
Diabetes is a risk factor for postoperative morbidity, which includes total hip and knee arthroplasty. However, no previous studies have been done in a fast-track setting with optimized perioperative care, including spinal anesthesia, multimodal opioid-sparing analgesia, early mobilization, and discharge to home, which improved postoperative outcome. ⋯ Type 2 diabetes per se has limited influence on postoperative morbidity in fast-track total hip and knee arthroplasty.