Journal of clinical anesthesia
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In 1994, Fischer et al. established the preoperative clinic for the perioperative services at Stanford University Medical Center. By lowering the risk of cancellation and reducing morbidity and mortality against the push to move surgeries to an outpatient, basis, they demonstrated a return on investment. ⋯ With a trend towards ambulatory procedures due to current reimbursement structures, hospital administrators should be searching for potential avenues to bolster sagging profits. In this narrative review, we argue that the perioperative services needs to extend beyond the hospital into the postoperative period.
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Review Meta Analysis
The utility of the Montreal cognitive assessment (MoCA) in detecting cognitive impairment in surgical populations - A systematic review and meta-analysis.
To determine the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment (CI) and assess the association of MoCA scores with adverse postoperative outcomes in surgical populations. ⋯ MoCA had been validated in the surgical population. MoCA with a cut-off score of <26 was shown to have 87% sensitivity and 72% specificity in identifying CI. A positive screen in MoCA was associated with a 3-day longer hospital LOS in cardiac surgery in the CI group than in the non-CI group.
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Randomized Controlled Trial Comparative Study
Assessing different brain oxygenation components in elderly patients under propofol or sevoflurane anesthesia: A randomized controlled study.
Elderly patients undergoing pathophysiological changes necessitate clinical tools for cerebral monitoring. This prospective randomized controlled study aimed to explore how cerebral monitoring using Δo2Hbi, ΔHHbi, and ΔcHbi manifests in elderly patients under either propofol or sevoflurane anesthesia. ⋯ In cerebral oximetry, Δo2Hbi and ΔHHbi could emerge as a valuable approach for discerning changes in the underlying baseline status of the brain in elderly patients during anesthesia.
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Postoperative nausea and vomiting (PONV) is a common sequela of surgery in patients undergoing general anesthesia. Amisulpride has shown promise in its ability to treat PONV. The objective of this study was to determine if amisulpride is associated with significant changes in PACU efficiency within a fast-paced ambulatory surgery center. ⋯ This study demonstrated that amisulpride was associated with a significant decrease in PACU length of stay among patients with PONV in a single outpatient surgery center. The downstream cost-savings and operational efficiency gained from this drug's implementation may serve as a useful lens through which this drug's widespread implementation may further be rationalized.
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Observational Study
Incidence and onset of central venous catheter-related thrombosis in critically ill surgical patients: A prospective observational single-center study.
Catheter-related thrombosis (CRT) is a major complication of central venous catheters (CVCs). However, the incidence, onset, and dependence of CRT on CVC material and/or type in critically ill surgical patients is unknown. Therefore, we here investigated the incidence, onset, and dependence of CRT on a variety of risk factors, including CVC material and type, in critically ill surgical patients. ⋯ Almost all CVCs in the internal jugular vein in critically ill surgical patients developed an asymptomatic CRT in the first days after catheterization.