American journal of therapeutics
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This article reviews certain aspects of venous thromboembolism, a major cause of morbidity and mortality among hospitalized patients. Deep vein thrombosis is a frequent complication of various surgical procedures. Knowing predisposing factors, including hereditary causes, and triggering risk factors will help us identify patients with high risk of venous thromboembolism. ⋯ However, those readers who want to adopt the American College of Chest Physicians' guidelines in their practices are urged to review in detail the pharmacology of the drugs used for thromboprophylaxis, relevant clinical studies, and case reports of spinal hematoma. Each patient might have different risks for thrombosis or bleeding and the potential for adverse consequences due to the prophylaxis. What is best for the group (the epidemiologic perspective) is not necessarily what is best for the individual patient (the clinical perspective).
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Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. ⋯ CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a somewhat unpredictable spread and duration of effect, CSA allows titration of the block level to the patient's needs, permits a spinal block of indefinite duration, and can provide greater hemodynamic stability than single-injection spinal anesthesia.
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With the common use of ultrasound imaging by anesthesiologists, especially for peripheral nerve blocks, this article will review basic physics of ultrasound machine, use of ultrasound in regional anesthesia, review of recent reports in the literature, and the outcome data.
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Nosocomial infections caused by methicillin-resistant Staphylococcus aureus were first reported in the United States in the early 1960s. Beginning in the 1990s, healthy individuals from the community with no risk factors for resistant bacteria began presenting with methicillin-resistant Staphylococcus aureus infections, acquiring the name "community-associated methicillin-resistant Staphylococcus aureus" (CA-MRSA). CA-MRSA has a tendency to affect the skin and skin structures, generally in the form of abscesses and furuncles, carbuncles, and cellulitis. ⋯ It has been suggested that when prevalence of CA-MRSA within a community eclipses 10%-15%, empiric use of non-beta-lactam antibiotics with in vitro activity against CA-MRSA be initiated when treating skin and skin structure infections. CA-MRSA retains susceptibility to a range of older antibiotics available in oral formulations such as minocycline, doxycycline, sulfamethoxazole-trimethoprim, moxifloxacin, levofloxacin, and clindamycin. Local susceptibility patterns and individual patient factors should guide the selection of antibiotics.