Articles: postoperative.
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Reg Anesth Pain Med · Jul 2015
Randomized Controlled Trial Comparative StudyRandomized Comparison of Extrafascial Versus Subfascial Injection of Local Anesthetic During Ultrasound-Guided Supraclavicular Brachial Plexus Block.
The optimal site for local anesthetic injection during an ultrasound-guided supraclavicular brachial plexus block (BPB) is not known. We tested the hypothesis that local anesthetic injected deep to the "brachial plexus sheath" during supraclavicular BPB would produce faster onset of surgical anesthesia than an injection superficial to the sheath. ⋯ Injection of local anesthetic deep to the brachial plexus sheath at the supraclavicular fossa, under ultrasound-guidance, results in faster onset of surgical anesthesia and prolonged duration of postoperative analgesia than an injection superficial to the sheath.
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Randomized Controlled Trial Comparative Study
Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in hip fracture patients.
Effective analgesia is essential for the postoperative care of orthopedic patients. ⋯ Continuous FIB is a safe and effective technique for postoperative analgesia after hip fracture surgery, making it an option for pain management in elderly patients with hip fractures.
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Anesthesia and analgesia · Jul 2015
Observational StudyThe Effect of Adding Functional Classification to ASA Status for Predicting 30-Day Mortality.
The functional capacity to perform the activities of daily living is identified as an independent predictor of perioperative mortality but is not formally incorporated in the American Society of Anesthesiologists (ASA) classification. Our primary objective was to assess whether functional capacity is an independent predictor of 30-day and long-term mortality in a general population and, if so, to define how it may formally be incorporated into the routine preoperative ASA classification assessment. ⋯ Functional capacity was an independent predictor of mortality within each ASA class, indicating that it should be considered for incorporation into the routine preoperative evaluation. Functional dependence may be an indication for increasing a patient's ASA class by 1 class-point to better reflect his or her perioperative risk, but prospective validation of these findings is recommended, as this is a preliminary study.
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Little is known about the relationship between intraoperative blood pressure variability and mortality after noncardiac surgery. Therefore, the authors tested the hypothesis that blood pressure variability, independent from absolute blood pressure, is associated with increased 30-day mortality. ⋯ Although lower mean arterial pressure is strongly associated with mortality, lower intraoperative blood pressure variability per se is only mildly associated with postoperative mortality after noncardiac surgery.
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In an effort to measure and improve the quality of perioperative care, the Surgical Care Improvement Project (SCIP) was introduced in 2003. The SCIP guidelines are evidence-based process measures designed to reduce preventable morbidity, but it remains to be determined whether SCIP-measure compliance is associated with improved outcomes. ⋯ Compliance with SCIP Inf-10 body temperature management guidelines during surgery is associated with improved clinical outcomes and can be used as a quality measure.