Journal of clinical anesthesia
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Multicenter Study Observational Study
Lack of generalizability of observational studies' findings for turnover time reduction and growth in surgery based on the State of Iowa, where from one year to the next, most growth was attributable to surgeons performing only a few cases per week.
Three observational studies at large teaching hospitals found that reducing turnover times resulted in the surgeons performing more cases. We sought to determine if these findings are generalizable to other hospitals, because, if so, reducing turnover times may be an important mechanism for hospitals to use for growing caseloads. ⋯ Most (≥50%) annual growth in surgery, both based on the number of total inpatient and outpatient surgical cases, and on the total outpatient RVU's, was attributable to surgeons who performed 2 or fewer cases per week at each hospital statewide during the preceding year. Therefore, the strategic priority should be to assure that the many low-caseload surgeons have access to convenient OR time (e.g., by allocating sufficient OR time, and assigning surgeon blocks, in a mathematically sound, evidence-based way). Although reducing turnover times and anesthesia-controlled times to promote growth will be beneficial for a few surgeons, the effect on total caseload will be small.
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Multicenter Study Observational Study
Prevalence of malignant hyperthermia diagnosis in hospital discharge records in California, Florida, New York, and Wisconsin.
Malignant hyperthermia (MH) is a rare yet potentially fatal pharmacogenetic disorder triggered by exposure to inhalational anesthetics and the depolarizing neuromuscular blocking agent succinylcholine. Epidemiologic data on the geographic variation in MH prevalence is scant. The objective of this study is to examine the prevalence of recorded MH diagnosis in patients discharged from hospitals in four states in the United States. ⋯ There exists a modest variation in the prevalence of recorded MH diagnosis in hospital discharges in California, Florida, New York and Wisconsin. Epidemiologic patterns of MH diagnosis in hospital discharges appear to be similar across the four states. Further research is needed to better understand the geographic variation and contributing factors of MH in different populations.
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Multicenter Study Comparative Study Clinical Trial
Fast-track anesthesia in patients undergoing outpatient laparoscopic cholecystectomy: comparison of sevoflurane with total intravenous anesthesia.
The use of short-acting anesthetics has introduced a "fast-track anesthesia" concept in outpatient surgery which provides discharge of the patients from operation room directly to the phase II recovery area without entering into postanesthesia care unit. The aim of this prospective and randomized study was to compare general anesthesia using sevoflurane with propofol-remifentanil-based total intravenous anesthesia (TIVA) for fast-track eligibility in patients undergoing outpatient laparoscopic cholecystectomy. The secondary aim was to compare 2 discharge scoring systems: White's Fast-Tracking Scoring System (WFTSS) and Modified Aldrete Scoring Systems (MASS) with regard to postanesthesia care unit bypass rate and postoperative problems. ⋯ The ratio of fast-track eligible patients was higher and times to fast-track eligibility were shorter in group TIVA compared with group sevoflurane (82.1% vs 57.5% and 8 minutes vs 12 minutes; P<.05). The primary factors that have inhibited fast-tracking were desaturation, hemodynamic instability, pain, and postoperative nausea and vomiting, respectively. Postoperative nausea and vomiting presented a major difference in the rate of fast-track ineligibility between groups (4 patients in group sevoflurane, whereas none in group TIVA; P<.05). The fast-track ratio was lower with the WFTSS compared with MASS in group sevoflurane (57.5% vs 77.5%, P<.05), but similar in group TIVA.
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Multicenter Study
Consequences of not relieving negative internal pressure of a medication vial: A survey and simulation study.
The glass vial of acetaminophen as an intravenous preparation (Acelio®, Terumo, Japan) has a strong internal negative pressure. The aim of our study was to determine if this negative pressure could result in medication administration errors if not released prior to connecting to the IV set. ⋯ A considerable number of anesthesiologists experienced consequences caused by the negative pressure inside the Acelio® vial. This can also cause aspiration of the contents of the syringe pump.
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Multicenter Study Comparative Study
Variability in anesthesiologists' approach to the preoperative management of asthmatic children.
No consensus guidelines exist for the preoperative treatment of asthmatic children referred for elective surgery. We investigated the attitude of pediatric anesthesiologists to this issue. ⋯ A wide variability exists in pediatric anesthesiologists' approach to the preoperative management of asthmatic children for most common case scenarios. This is probably explained by the heterogeneity of asthma, the type of surgery, the lack of guidelines, and the paucity of data. Similarities as well as differences exist between pediatric anesthesiologists and pulmonologists. Further studies and implementation of consensus guidelines are needed.