Journal of clinical anesthesia
-
Intravenous patient-controlled opioid analgesia (IVPCA), epidural analgesia and transversus abdominis plane (TAP) infiltrations are frequently used postoperative pain management modalities. The aim of this study was to conduct a cost-effectiveness analysis comparing the use of epidural, IVPCA, and TAP infiltrations with liposomal bupivacaine for analgesia in the first 72 h postoperatively in patients undergoing major lower abdominal surgery. ⋯ This is the first study in the literature to compare the cost-effectiveness of epidural, IVPCA, and TAP infiltrations with LB. Within reasonable WTP values, there is little differentiation in cost-effectiveness between IVPCA and TAP infiltration with LB. Epidural does not become a cost-effective strategy even at much higher WTP values.
-
Switching from one specialty to another increases mean turnover times (i.e., interval between the exit and entrance of consecutive patients in an operating room [OR]). We estimate the effect on the mean tardiness of to-follow surgeons from following another surgeon of a different versus same specialty. Tardiness of a case's start time refers to the number of minutes the patient enters the OR later than scheduled; tardiness is 0 min if the patient enters early. Tardiness cause surgeon waiting. There are multiple causes of tardiness, but, most often, the preceding case(s) took longer than estimated. ⋯ OR managers can assure surgeons with afternoon starts that following a surgeon of a different specialty generally will not increase their waiting time. Case scheduling should focus on reducing over-utilized OR time and thus the hours that anesthesiologists and nurses work late.
-
Letter Case Reports
Caution when using pumps for intravenous fluid infusion on a tucked limb.
-
Letter Case Reports
Combined use of peripheral nerve blocks for multilevel spine surgery.
-
The aim of this study was to assess the impact of intravenous general anesthesia and controlled hypotension on cerebral saturation (rScO2), cerebral blood flow measured as middle cerebral artery blood flow velocity (Vmax MCA) and neurobehavioral outcome in patients scheduled for shoulder surgery in beach chair position. ⋯ In ASA I-II patients intravenous general anesthesia and controlled hypotension in the beach chair position affects cerebral blood flow and cerebral oxygenation with impact on the neurobehavioral outcome.