Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2018
ReviewA Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science.
Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinary reputation, quality, and/or service, whereas its destruction can be a consequence of poor management, unfavorable policy, decreased demand, and/or increased competition. ⋯ Therefore, a sustainable population health strategy needs to be comprehensive and thus include perioperative medicine as an essential component of the complete cycle of patient-centered care. We describe a multidisciplinary integrated program to support perioperative medicine services that are integral to a comprehensive population health strategy.
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Anesthesia and analgesia · Feb 2018
ReviewPearls of Wisdom for High-Risk Laser Lead Extractions: A Focused Review.
Due to new indications and improved technology, the incidence of laser lead extraction (LLE) has significantly increased over the past years. While LLE has been well studied and proven to be safe and effective, only few studies are geared toward the anesthesiologist's role during high-risk LLEs. This article utilized both a focused review and authors' experience to investigate anesthetic protocols during LLEs. Through this review, we recommend best practices for the anesthesiologist including appropriate procedure location, onsite availability of a cardiac surgeon, availability of a cardiopulmonary bypass machine, and intraoperative use of echocardiography to detect and address potential complications during high-risk LLEs.
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Anesthesia and analgesia · Feb 2018
Multicenter Study Clinical Trial Observational StudyThe Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients.
There is limited data on prehospital administration of tranexamic acid (TXA) in civilian trauma. The aim of this study was to evaluate changes in coagulation after severe trauma from on-scene to the hospital after TXA application in comparison to a previous study without TXA. ⋯ Early prehospital administration of TXA leads to clot stabilization and a reduction of fibrinolytic activity, causing a decrease in fibrin degradation products buildup (D-dimer).
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Anesthesia and analgesia · Feb 2018
ReviewInformed Consent and Cognitive Dysfunction After Noncardiac Surgery in the Elderly.
Cognitive dysfunction 3 months after noncardiac surgery in the elderly satisfies informed consent thresholds of foreseeability in 10%-15% of patients, and materiality with new deficits observed in memory and executive function in patients with normal test performance beforehand. At present, the only safety step to avoid cognitive dysfunction after surgery is to forego surgery, thereby precluding the benefits of surgery with removal of pain and inflammation, and resumption of normal nutrition, physical activity, and sleep. To assure that consent for surgery is properly informed, risks of both cognitive dysfunction and alternative management strategies must be discussed with patients by the surgery team before a procedure is scheduled.
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Anesthesia and analgesia · Feb 2018
Randomized Controlled Trial Comparative StudyRandomized Controlled Trial of the Clinical Efficacy of Multiport Versus Uniport Wire-Reinforced Flexible Catheters for Labor Epidural Analgesia.
The purpose of this prospective, randomized, controlled trial was to determine whether multiple ports improve the analgesic efficacy of wire-reinforced flexible catheters used for labor epidural analgesia (LEA). ⋯ Multiple ports do not appear to improve the analgesic efficacy of wire-reinforced flexible catheters used for LEA.