Anesthesiology
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Many health-care institutions are emphasizing cost reduction programs as a primary tool for managing profitability. The goal of this study was to elucidate the proportion of anesthesia costs relative to perioperative costs as determined by charges and actual costs. ⋯ Anesthesia comprises 5.6% of perioperative costs. The influence of anesthesia practice patterns on "downstream" events that influence costs of hospitalization requires further study.
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Uncontrolled increase in intracranial pressure is the most significant cause of mortality in patients with severe traumatic brain lesions, and the efficacy of common non-surgical treatments has been questioned. Pharmacologically induced cerebral vasoconstriction aiming at a decrease of cerebral blood volume and brain edema has recently been suggested as an alternative. Limited clinical experience with indomethacin as a cerebral vasoconstrictor has been reported but dose- or concentration-effect relationships were not investigated. In particular, there is a lack of data showing whether a therapeutic window exists in which risk of cerebral ischemia is minimized. ⋯ Indomethacin, which is known to constrict precapillary resistance vessels, caused a decrease in intracranial pressure during experimental intracranial hypertension. This was accompanied by signs of cerebral ischemia when indomethacin was used in a dose that has previously been suggested for the treatment of increased intracranial pressure in patients.
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Up to 30% of all deaths attributable to anesthesia are related to difficulties with airway management. The purpose of this study was to determine whether anesthesiology residents are receiving specialized instruction in the various techniques and mechanical devices currently recommended for airway management in patients with anticipated or unanticipated difficult airways. ⋯ Based on the data obtained by the authors, formal instruction in difficult airway management is not offered by most residency programs. It is commonly taught as difficult clinical situations arise. Because these difficulties occur sporadically, opportunities for teaching are occasional. Learning based on sporadic and occasional occurrences risks incomplete and nonuniform training of residents.
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Letter Historical Article
Early French accounts of self-inhalation of ether and conscious analgesia.